gender, class, and madness in nineteenth century france

Society for French Historical Studies

Gender, Class, and Madness in Nineteenth-Century FranceAuthor(s): Jill HarsinSource: French Historical Studies, Vol. 17, No. 4 (Autumn, 1992), pp. 1048-1070Published by: Duke University PressStable URL: http://www.jstor.org/stable/286842 .

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REVIEW ESSAY

Gender, Class, and Madness in Nineteenth-Century France

Jill Harsin

She almost never left her cell, and usually stayed lying down. When she did go out, she would be naked, or wearing a chemise. She would take only a few steps, and generally she would walk on all fours, stretching her body out on the ground; with staring eyes, she would pick up any morsels which she found on the floor and eat them. . . . She drank water from the gutters, while the courtyards were being cleaned, although this water was polluted and full of ex- crement, preferring this drink to any other. . . . Finally, on 9 June, she expired, at the age of fifty-seven, without having recovered the use of her reason, even for a moment.'

Jean Etienne Dominique Esquirol's famous description of the last years of Theroigne de Mericourt, based on his observations of her at the Salpetriere, raises troubling questions about the history of women and madness in the nineteenth century. Theroigne's2 living conditions, re- ducing her to brutishness, gave the lie to the improvements that had supposedly come with the Revolution (her bed was covered with straw,

Jill Harsin is associate professor of history and department chair at Colgate University. She is the author of Policing Prostitution in Nineteenth-Century Paris (Princeton, 1985).

1 From Jean Etienne Dominque Esquirol, Des maladies mentales, 2 vols. (Paris, 1938), 1:445-51, quoted in Elisabeth Roudinesco, Theroigne de Mericourt: A Melancholic Woman during the French Revolution, trans. Martin Thom (London, 1991), 172-73. In addition to this work, the following books will be reviewed in this article: Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (New York, 1987); Joelle Guillais, Crimes of Passion, trans. Jane Dunnett (New York, 1990); Ruth Harris, Murders and Madness: Medicine, Law, and Society in the fin de siecle (New York, 1989); and Yannick Ripa, Women and Madness: The Incarceration of Women in Nineteenth-Century France, trans. Catherine du Peloux Menage (Minneapolis, Minn., 1990).

2 Her name was Anne-Josephe Terwagne; Theroigne de Mericourt was a corruption of her last name and the town (Marcourt) in which she had lived.

French Historical Studies, Vol. 17, No. 4 (Fall 1992) Copyright ?) 1992 by the Society for French Historical Studies



GENDER, CLASS, AND MADNESS 1049

according to Esquirol, and the floor of her cell "was paved with stone and flooded with water"; "when everything iced over," she would break the ice with her hands and sprinkle it over her feet).3 The humane moral treatment, pioneered only a few years earlier by Dr. Philippe Pinel, had largely passed her by, though her relative harmlessness allowed her to wander about the asylum unrestricted.4 Esquirol attributed her illness to her earlier status as a courtesan and to her revolutionary activities ("she gave herself to various leaders of the party," he wrote, thus con- flating debauchery and political radicalism), finally driven insane by the extremes of the revolutionary era.5

For the past several decades, the broad outlines of the history of madness and psychiatry in the nineteenth century, particularly in west- ern Europe and the United States, have become visible. France and Brit- ain were the early leaders in the field, and in both countries events occurred in the late eighteenth century that focused attention on the issues of madness. In Britain the chief problem was the stability of George III, who had his first major bout of insanity in 1788-89. This governmental crisis led to the calling of Dr. Francis Willis, the famous "mad-doctor' regarded by more orthodox physicians as little better than a charlatan.6 Pinel, the acknowledged founder of psychiatry in France, praised the work of Willis in print and helped to incorporate it into a respectable medical framework, something that the eccentric Willis could not do.

In France, in contrast, the crisis that focused attention on insanity-and opened a career to the outsider Pinel-was more tho- roughgoing and profound: the French Revolution, which seemed at first to promise liberation for all those, including beggars, vagabonds,

3 Esquirol, Des maladies mentales, 1:445-51, quoted in Roudinesco, Theroigne deMericourt, 171-72.

4 In contrast, Edward Wakefield reported after a visit to London's famous Bethlem that in the women's galleries, "one of the side rooms contained about ten patients each chained by one arm or leg to the wall; the chain allowing them merely to stand up by the bench or form fixed to the wall, or to sit down on it. The nakedness of each patient was covered by a blanket-gown only; the blanket-gown is a blanket formed something like a dressing-gown, with nothing to fasten it with in front." The testimonies of Wakefield and others led to the Parliamentary inquiry of madhouses in 1815-16. Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry, 1535-1860 (London, 1963), 699.

5 Esquirol, Des maladies mentales, 1:445-51, quoted in Roudinesco, Theroigne de Mericourt, 170.

6 Willis, a clergyman and an Oxford M.D., had run a private madhouse for many years but was regarded by most physicians as a "mountebank." Roy Porter, A Social History of Madness (New York, 1989), 46. On George III, see also Ida Macalpine and Richard Hunter, George III and the Mad Business (London, 1969). In addition to George III's illness, the opening of the Tukes' York Retreat in 1796 and the Parliamentary inquiries in 1807 and 1815 brought significant public attention. Roy Porter, Mind-Forg'd Manacles: A History of Madness in England from the Resto- ration to the Regency (Cambridge, Mass., 1987), 3.



1050 FRENCH HISTORICAL STUDIES

and the insane, who had been caught up in what Michel Foucault has referred to as the "great confinement." A few believed, if only briefly, that creating a new world free from oppression would end all causes of insanity; this revolutionary hope was symbolized by Pinel's semimyth- ical decision to strike off the chains of the inmates of Bicetre.7 However, as Foucault, Robert Castel, and others have pointed out, the Revolution linked the treatment of the insane even more fully than before to the "total institution" (institution totalitaire) reminiscent of the institutions of despotism.8 In the long history of insanity, the nineteenth century became the century of the asylum.

The process of institutionalization gained momentum, especially as a solution for the insane poor. The 1838 law on a lienes in France was the milestone that required each department in France to provide an asylum.9 The idea behind the asylum was the assumption that isolation from family and society was part of the cure; careful consideration of the problems of each patient, a part of Pinel's new methods, would do the rest. As the asylums became overcrowded, moral therapy gave way to simple, sometimes brutal, custodial care. But even as the ambitions for the asylum died, "insanity" had become the subject of a distinct branch of medicine in the hands of alienists who received specific training and who aggressively insinuated their specialized skills into the courtrooms, claiming that their expertise alone could determine responsibility and guilt.

Psychiatrists now claimed a unique authority in understanding the criminal poor, whose actions aroused concerns about "morbid heredity" and degeneration, and the psychiatric evaluation became standard practice in the courtroom, particularly in the numerous crimes of

7 The decision to unchain the mad-the symbolic beginning of an end to the barbarity of their treatment-has been traced by Gladys Swain, who has argued that though there was no "moment" when this occurred, there was a general substitution of camisoles deforce for chains. The date on which this occurred was a subject of some debate. Pinel placed it in the year III, in a publication of 1823; and his son Scipion Pinel (in a work published in 1836) placed it in 1792, also adding the apprehensive figure of Couthon at the supreme moment. Later, Pinel actually attributed the unchaining to his concierge Pussin, who liberated some forty madmen who had been chained for many years. Gladys Swain, Le Sujet de laf olie: Naissance de la psychiatrie (Toulouse, 1977), 43-47.

8 Robert Castel, L'Ordre psychiatrique: L'Age d'or de l'alienisme (Paris, 1976), 59-60. 9 In Britain similar laws were passed in 1808, which authorized but did not require county

madhouses to be built; and in 1845, which required the building of county madhouses. In the meantime, private madhouses contracting with the county had become a mainstay of the system. William LI. Parry-Jones, The Trade in Lunacy: A Study of Private Mad houses in England in the Eighteenth and Nineteenth Centuries (London, 1972), 15-16. In France older asylums, including those run by clerics, were tolerated until the late nineteenth century. Goldstein, Console and Clas- sify, 308; according to Castel, as early as 1839 the Ministry of the Interior cautioned departmental prefects against overspending on asylums and suggested cooperation among departments. Castel, L'Ordre psychiatrique, 234.




passion of the late nineteenth century. Alienists also asserted a particular expertise in the treatment and understanding of women, who were frequently regarded as the victims of their own biology. By the late nineteenth century, the obvious weakness of women was on display every week in the famous "Tuesday lessons" of Dr. Jean-Martin Charcot of the Salpetriere, who displayed his hysterical (usually working-class and female) patients before bourgeois male audiences.

It is only in recent years that the issue of class and, even more re- cently, that of gender, have received serious attention as aspects of the history of insanity in the nineteenth century. While the earliest histories tended to be whiggish treatments of the great men of psychiatry, 10 studies of the last several decades have often become enmeshed in the antipsychiatry debate of Foucault, Thomas Szasz, and R. D. Laing," focusing on the asylum as one of several total institutions meant to mold unsuitable citizens to the requirements of nineteenth-century bourgeois society.'2 Under the influence of this particular critique, medical treatment of insanity is viewed as an upper-class maneuver against the dispossessed, as expressed in Klaus Doerner's assertion that "the bourgeoisie established psychiatry specifically for the poor insane." 13 In regard to gender issues, the late nineteenth-century epidemic of hysteria and other "nervous" diseases has received particular attention in recent years as an example of the tendency to pathologize the feminine condition, because women made up the majority of those di- agnosed with these new ailments and, by the late nineteenth century, represented the majority of those incarcerated in asylums. In this essay I will survey some of the most recent studies of madness and psychiatry in the nineteenth century, with particular attention to class and gender.

Theroigne de Mericourt, the subject of the most recent study by Made-

10 For example, Dr. Rend Semelaigne, Les Pionniers de la psychiatriefran(aise avant et apres Pinel, 2 vols. (Paris, 1930).

11 See Peter Sedgwick, Psycho Politics (New York, 1982), for an analysis of the antipsychiatry movement. See also Elaine Showalter, The Female Malady: Women, Madness, and English Cul- ture, 1830-1980 (New York, 1985), 220-47, for a discussion of R. D. Laing.

12 In an influential study, Erving Goffman described a number of different kinds of "total institutions," such as mental hospitals, penitentiaries, army barracks, monasteries, and ships. His own work focused on the asylum. See Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (New York, 1961), 6-12. See as further influential studies in this vein Andrew T. Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (New York, 1979); and Michael Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution, 1750-1850 (New York, 1978).

13 Klaus Doerner, Madmen and the Bourgeoisie:A Social History of Insanity and Psychiatry, trans. Joachim Neugroschel and Jean Steinberg (Oxford, 1981), 1; what led to psychiatry was the "social visibility of unreason, that is, of madmen as 'pauper lunatics'," ibid., 37.




leine Roudinesco, was one of the most notorious activists of the revolutionary period. She was also the victim of one of the most famous incidents of psychic violence in the Revolution: on 15 May 1793, in front of the Convention, she was attacked by several enraged women who pulled up her skirts and whipped her bare skin. Jean-Paul Marat, only two months away from his assassination, protected her from these women, who were of his own party, and escorted her away.'4

From this moment on Theroigne dropped out of sight. One of her brothers reported her "insanity" to the authorities just before the fall of Robespierre. Shortly thereafter she was arrested by the Revolutionary Committee of her section, leading Roudinesco to suspect that the brother's report, meant to forestall the arrest, may well have been an act of protection. At the time of her arrest Theroigne was found to be suffering from delusions of persecution, although it was "hard to decide during this period just who was really being persecuted and who was suffering from delusions."'5 She was freed in December 1794, on her petition; within weeks, her brother had her committed once again. In 1797 she was sent to the Hotel-Dieu, and in December 1799 she was among those sent to the Salpetriere, a transfer designed to give Director Pinel an opportunity to work with some potentially "curable" patients. When she protested again, she was sent to the Petites-Maisons hospital, only to turn up in the Salpetriere again in 1807, where she would remain until her death in 1817. During the last six years of her life, the Salpetrieire was in the charge of Esquirol, Pinel's disciple.

Esquirol's famous description, along with the drawings he had made of her by the artist Georges-Francois Gabriel (whose previous career had included waiting at the scaffold to draw the faces of those about to die), fixed definitively the final image of Theroigne.'6 But was she mad at all, or was she simply the victim of a misogynist government that defined any politically active woman as mad? Roudinesco does provide suggestive evidence that she was unbalanced at the beginning of

14 Roudinesco, Theroigne de Mericourt, 138. 15 Ibid., 145. 16 According to Esquirol, he had had more than two hundred of the insane sketched as a part

of his study of madness. Unlike the phrenologists, who concentrated on the size and shape of the skull, Esquirol specified illustrations that emphasized the expression and position of the face and, often, of the full body. See Jean Etienne Dominique Esquirol, Des maladies mentales, considerees sous les rapports medical, hygienique, et medico-legal (Paris, 1838), 2:167, cited in Sander L. Gilman, Disease and Representation: Images of Illness from Madness to AIDs (Ithaca, N.Y., 1988), 34. The artist for many of his drawings was Ambroise Tardieu. The case history and illustra- tion of two of the patients in his book were mixed up, a mistake not discovered either by Esquirol or by his readers, which says much about "perceptions" of the insane. See Janet Browne, "Darwin and the Face of Madness," in The A natomy of Madness Vol. 1: Peop le and Ideas, ed. W. F. Bynum, Roy Porter, and Michael Shepherd (London, 1985), 1:155.




her life in the wards.17 Esquirol believed that the Revolution had brought on her insanity; in contrast, Roudinesco suggests that the Revolution most likely "masked" the madness that was already there. Theroigne's alternations between despair and frenzy, her manic-depressive states, echoed the ebbs and flows of the Revolution. When order returned once more to French politics, Theroigne did not change with it, and her own instability was thrown into relief. Later, after Theroigne had been con- fined in various hospitals for more than ten years, she had become a curiosity, a living relic of the Reign of Terror: "She was in a highly agitated state, and would swear, threaten those about her, speak of liberty and of the Committee of Public Safety, and accuse anyone who came near of being a royalist or a moderate'98- behavior that had indeed been masked during the Year II. This sensitive portrayal allows us to see Theroigne's life through the veil of the insanity that obscured her to her contemporaries, but it is probably not coincidental that one of history's most famous madwomen appeared precisely at the beginning of modern psychiatry.

Pinel and his work are discussed in Jan Goldstein's Console and Classify, a superb intellectual history of French psychiatry in the nineteenth century. Two of the fundamental bases of the profession in the nineteenth century-the notion that the insane might be "curable," and the idea of the hospital, or asylum, as a machine a guerir'9-had been put forward in the last years of the ancien regime, whose administrators had devoted two wards of the Hotel-Dieu to the curable insane.20 However, French psychiatric history really starts with the French Revolution, its advent marked by the publication of Pinel's Traite medico-philosophique sur l'alienation mentale, ou la manie, in 1801. He recommended the inno- vation of the "moral treatment," defined by Goldstein as "the use for the cure of insanity of methods that engaged or operated directly upon the

17 Roudinesco cites a letter written after her arrest to Saint-Just on 8 Thermidor and found still sealed among his papers after his death. The letter was rational in its purpose: Saint-Just was a neighbor of hers, and as the author of the law regarding the liberation and property of patriots who had been detained (8 Vent6se, Year II), he was the most logical person- to release her from her recent confinement. On the other hand, one has only to read the letter: "We must establish union; I must have the opportunity to develop all my projects and to continue to write what I was writing. I have great things to say. . . . I could still put everything to rights, if you would second me." Roudinesco, Theroigne de MWricourt, 147-48.

18 Ibid., 154. 19 The phrase used by Dr. Jacques Tenon: Goldstein, Console and Classify, 47. 20 The H6tel-Dieu was the first stop for the mentally ill, who stayed for six weeks and might be

able to stay for six more if necessary. Only then were they admitted to the Bicetre and Salpetriere, the places for incurables. H. C. Erik Midelfort, "Madness and Civilization in Early Modern Europe: A Reappraisal of Michel Foucault," in After the Reformation: Essays in Honor of J. H. Hexter, ed. Barbara C. Malament (Philadelphia, Pa., 1980), 256.




intellect and emotions, as opposed to the traditional methods of bleedings and purgings applied directly to the lunatic's body.''2'

In specific terms the moral treatment implied, most importantly, a "gentleness" that had been absent in the previous regime of chains, though the old buildings with their ghastly physical conditions lin- gered long into the new era. At the same time, the healer had to be able to exercise a commanding authority over the patients, an aspect of psychiatry that would later reach its highpoint in the "Caesarism" of Jean- Martin Charcot.22 Finally, moral treatment worked through an individual evaluation of the delusions of each patient. Once Pinel had defined the problem, he deliberately created artificial and contrived situations such as a phony "trial" before a Revolutionary Tribunal -to shock patients out of their aberrations.23

The difficulty with such methods was that they did not necessarily require a medical degree-a matter of great significance to Goldstein, who is concerned to trace the development of psychiatry as a profession. In the context of the Revolution, the moral treatment was, as Goldstein notes, "politically correct." First, it depended for its success on close clinical observation (because each treatment had to be devised individ- ually for each patient), and clinical observation, as opposed to deduc- tive reasoning from hallowed medical texts, was the new wave of medical practice. Moral treatment also acknowledged the important

21 Goldstein, Console and Classify, 65; Scull has a far less benign definition of moral treatment: "moral treatment activity sought to transform the lunatic, to remodel him into something approximating the bourgeois ideal of the rational individual. From this viewpoint, the problem with external coercion was that it could force outward conformity, but never the necessary inter- nalization of moral standards." Andrew Scull, "Moral Treatment Reconsidered: Some Sociologi- cal Comments on an Episode in the History of British Psychiatry," in Mad houses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadel- phia, Pa., 1981), 11 1. The Parliamentary Inquiry of 1815-16 revealed the following about the standard medical treatment of the day, in this testimony about Bethlem: "[Patients] are ordered to be bled about the latter end of May, or the beginning of May, according to the weather; and after they have been bled they take vomits once a week for a certain number of weeks, after that we purge the patients." Patients were kept chained to their beds at least four days a week; cited in Andrew T. Scull, "From Madness to Mental Illness: Medical Men as Moral Entrepreneurs," Archives europeennes de sociologie 16 (1975): 2:229. Goldstein notes that the next generation, including even Scipion Pinel, was often inclined to use the moral treatment in conjunction with physical treatments, such as bleedings and purgings, stemming from a belief in "reciprocal psychosomatic influence." Goldstein, Console and Classify, 264-65, 267.

22 L. Daudet, Les Morticoles (Paris, 1894), cited in Georges Didi-Huberman, Invention de l'hysterie: Charcot et l'iconographie photographique de la Salpetriere (Paris, 1982), 21.

23 One of Pinel's "pious frauds" that seems most clearly related to Theroigne concerned one of his patients of the Year II, a tailor who feared that he would be brought before the Revolutionary Tribunal. He was suddenly surprised in his cell by several young interns disguised in black j udi- cial robes. They proceeded to try him, and ended by pronouncing him innocent of the charges, a harmless bit of spectacle that had the effect of shocking him out of his obsession. Roudinesco speculates that Theroigne's fixation with the Reign of Terror could have led to a similar enact- ment for her. Roudinesco, Theroigne de MWricourt, 161-62.




role of dedicated lay healers, often from humble backgrounds (like Pus- sin, the concierge in the Bicetre and Salpetriere, from whom Pinel de- rived much of his information),24 who had been unjustly slighted in the previous regime. And finally, the method of gentleness also seemed more appropriate for those who, in many cases, had been victimized by the abuses of the past: perhaps sane when first locked up, many of the incarcerated were now found by revolutionary investigators to be hope- lessly insane.

The challenge for the proponents of the moral treatment was to make it into a legitimate medical therapy under the control of physicians. Pinel freely acknowledged that his key concepts of moral treatment came from medical "quacks," such as Francis Willis and, most importantly, Pussin.25 It was the immediate task of the fledgling science of psychiatry to find ways to differentiate itself from these untrained, and especially from clerical, healers.

Pinel provided a significant philosophical and scientific j ustifica- tion for the new methods, but the task of establishing "mental medicine" as a specialty fell to Pinel's disciple, Esquirol. Pinel was preeminently a nosographer intent upon devising a new classificatory scheme for disease and was widely known in his own day for his general expertise. Esquirol, in contrast, became a specialist in mental medicine, arguing for the construction of institutions, to be called asylums, and for the substitution of the new term alienation for the ancient term folie.26 Esquirol's-and psychiatry's-ultimate success had much to do with his skill as a patron of young disciples of his own, cultivating in

24 At Pinel's request, Pussin wrote a brief account of his methods (he had been superintendent of the ward for incurable mental patients at Bichtre since 1784), in which he revealed that he had used the methods of "gentleness" even before Pinel's arrival there. See Dora B. Weiner, "The Ap- prenticeship of Philippe Pinel: A New Document, 'Observations of Citizen Pussin on the In- sane'," American Journal of Psychiatry 136 (September 1979): 1128-34.

25 Pinel included on his list John Haslam, the apothecary of Bedlam; an "honest concierge" at the public institute for the insane in Amsterdam; and Pare Poution, an elderly monk. A significant omission from this list of lay healers was William Tuke, of the York Retreat. Anne Digby thinks that Pinel and the Tukes had little mutual influence. Pinel also dismissed the work of Vin- cenzo Chiarugi in Florence, who had "liberated" his own patients in 1788. Anne Digby, Madness, Morality, and Medicine: A Study of the York Retreat, 1796-1914 (Cambridge, 1985) [a study of the Quaker institution founded by the Tukes family], 32, 30.

26 Some recent works, including those of Roudinesco and Swain, have accused Esquirol, supposedly eager to establish the reputation of "founder" for himself, of downgrading Pinel's role to gentle humanitarianism, the dramatic geste liberateur of striking the chains off the inmates of Bicetre, and then attributing to himself the task of establishing the principles of psychiatry on a firm foundation. Goldstein rejects a villainous role for Esquirol, stressing instead a "filiopiety" so intense that Esquirol waited until he himself was in his mid-forties, and Pinel in his mid-seventies, before striking out on his own. At the same time, she regards Esquirol as indeed the first specialist in mental medicine. See also Robert Castel, L'Ordre psychiatrique, 105-9.




them an esprit de corps and placing them in institutions throughout France.

One of the most striking bids for recognition and for the extension of the alienists' territory came in 1825, when Esquirol's gifted student Etienne-Jean Georget introduced the notion of monomania as a possible insanity defense in the courtroom. Insanity had generally been judged on a common sense basis; monomania, in contrast, could only be judged by a specialist whose clinical training gave him the expertise to recognize difficult cases. Monomania was not completely new. Es- quirol had described intellectual or ideational monomania, the preoc- cupation with a single idea; Georget in contrast described volitional monomania, a condition that drove individuals to commit specific crimes-such as homicidal monomania for example (and similar to Pinel's manie sans delire). The volitional monomaniac could easily masquerade as a sane person, his condition detectable only by an expert.27

The concept of monomania immediately aroused controversy. Not only did it give the physician an important function in the courtroom, his expertise elevated above that of the lawyers, but it also seemed to embody a "militant liberalism," in that it potentially allowed criminals to escape the harsh punishments of the Restoration. Further, because Georget and others limited this new function to specialists in maladies mentales, they even irritated the majority of physicians. Monomania came under attack as a disease category in the 1850s, and within a few decades had virtually ceased to be used by specialists. By that time, however, alienists had firmly established themselves in the courtroom.

The story that Goldstein begins -the intrusion of alienists into the legal realm-is carried through to the late nineteenth century in Ruth Harris's excellent study, Murders and Madness, when medicine had firmly established itself as a partner in the courtroom system. It was not, to be sure, entirely an easy partnership. The Penal Code, shaped by the reforms of the Enlightenment, was founded on the assumptions of

27 The notion of disguise was critical again, as in the case of the "masking" of Theroigne's manic depressiveness. Robert Castel, a critic of psychiatry, has noted the increasing tendency of psychiatrists in the nineteenth century to regard normality as the disguise in certain individuals, with the essential "truth" of a person resting in madness hidden from the general public. Castel notes the case of an aliene named Griffith, who escaped from an asylum, found work, and lived "normally" until recognized as a former asylum inmate; remarked J. Moreau de Tours, "La con- duite d'un alidne peut ressembler dans beaucoup de circonstances a celle d'un homme raison- able. . . . Combien les apparences peuvent en imposer et donner le change sur la situation mentale rdelle d'un accuse." Quoted from "Revue MWdicale des journaux judiciaires," Annales medico-psychologiques 5 (1845): 118, in Castel, L'Ordre psychiatrique, 187.




free will and responsibility, with the aim of applying equal penalties to equal actions. Psychiatry was increasingly deterministic, stressing ele- ments that were uncontrollable by the individual, such as heredity and environment, and arguing against a fixed schedule of punishments. The new penal reformers at the end of the century argued for a flexibil- ity in sentencing28 that would allow the court to take into account the unique circumstances of each criminal and-more ominously-to consider in their penalties the possible dangers such an individual might pose in the future.

Harris suggests, however, that the divisions between the two professions were in fact not so rigid. Psychiatrists often spoke of the need for "strength of will" in the criminals they examined, stressing that bad impulses could be controlled. Lawyers, for their part, frequently allowed the psychological question of "why" a crime was committed to become as important as the determination of the facts of the case. And after 1880, in general, alienists became less concerned with the civil rights of the individual and more concerned with the problem of "social defense," or of the defense of a society at risk against these diseased (perhaps hereditarily diseased) individuals.

Attempts earlier in the century to find a siege for insanity in damaged or malformed organs had been disappointing; by the late nineteenth century, psychiatrists generally held to the assumptions of "diffuse, unlocalized, 'functional disturbances,' " a sort of "destabilization" theory of the "interior milieu" that could clearly have great implications in regard to women, whose internal workings were frequently seen as destabilized.29 This theory also allowed alienists to consider the effects of drugs, alcohol, and the working-class environment on an individual's behavior. It was believed that damaged individuals-those who became destabilized in some way-could pass on this "destabilization" to their offspring, not in the form of specific traits but rather in the form of a predisposition to some sort of defect. In this way, both heredity and environment could be seen to operate, though perhaps not immediately; there was a sort of "capital accumulation" of bad heredi- tary traits over several generations, which was then spent at once, in a

28 As in the "individualization of penalties" of Raymond Saleilles, L'Individualisation de la peine (Paris, 1898).

29 According to this view, the meaning of "lesion" defined as an injury to an organ that would be revealed by autopsy, had been changed; according to Dowbiggin, B. -A. Morel now introduced a definition of lesion as "a functional injury, an often temporary physiological condition leaving no trace of its presence." Ian Dowbiggin, "Degeneration and Hereditarianism in French Mental Med- icine 1840-90: Psychiatric Theory as Ideological Adaptation," in Bynum, Porter, and Shepherd, eds., The Anatomy of Madness, 206.




single unfortunate individual. French criminologists were thus able to avoid the excesses of the Lombroso school, instead emphasizing "a con- stant interaction between pathological agents and susceptible envi- ronmental conditions," but they did not escape "criminalizing" the poor, as products of their heredity as well as their environment.30

All of this makes up the necessary background to understanding the nature of courtroom trials in late nineteenth-century France, particularly those involving crimes of passion, in which the accused individuals came in for intense scrutiny of their social class, politics, gender, manie're de vivre, and (perhaps most significantly) their self- presentation in court.3' In these circumstances the accused had a significant role to play, conforming to social expectations by their demeanor in court and sometimes by submitting autobiographical memoirs- perhaps written at the request of the judge32- that might serve to ex- plain their actions. This intense individual scrutiny often resulted in acquittal of many criminels passionnels who were unquestionably guilty along with a wide variety of sentences imposed on those who were actually found guilty.

Stereotyped gender roles clearly influenced those decisions. When accused men claimed passion as their motivation, the courts always looked carefully at the behavior of the female victim and acquitted the accused if his victim could be shown to have failed in some way, usually by sexual infidelity or by a dereliction of housewifely duties. The behavior of women accused of crimes of passion had to coincide with pre- vailing views of female nature: women who claimed to have been deceived or abandoned were approved, whereas those who openly expressed the desire for independence and sexual freedom were frowned upon. Women often resorted to impassioned self-dramatization as the only way to win sympathy, even arousing suspicion that they were only playing a part, but the stories they were forced to tell also confirmed the general view of women as basically irresponsible: women "were simul- taneously excused and dismissed."33 Although psychiatric examina- tions of female criminals rarely resulted in a diagnosis of full-fledged hysteria, Harris notes that these women were seldom judged to be completely normal, because psychiatrists nearly always linked their crimi-

30 Harris, Murders and Madness, 29, 35, 69, 88. 31 See also Ruth Harris, "Melodrama, Hysteria, and Feminine Crimes of Passion in the Fin-

de-siecle," History Workshop 25 (1988): 31-63. And, for Great Britain: Roger Smith, Trial by Medicine: Insanity and Responsibility in Victorian Trials (Edinburgh, 1981).

32 Pierre Riviere's statement was written during his detention. See Michel Foucault, ed., Moi, Pierre Riviere, ayant egorge ma mere, ma soeur et mon frere . . .(Paris, 1973).

33 Harris, Murders and Madness, 227.




nality to some sort of nervous "destabilization" or to some anomaly in their family history.

Harris's study is usefully supplemented with Madeleine Guillais's Crimes of Passion, a study of this kind of crimes committed in the department of the Seine between the years 1870 and 1880. The total numbers of crimes of passion were not large: in the department of the Seine there were eighty males and nine females who committed such crimes during the decade, and statistics indicate that the majority of the victims were working-class women. It is on the women as victims that Guillais has chosen to concentrate.34

Through an analysis of what caused their working-class spouses or lovers to kill them, Guillais emphasizes the relative freedom of working-class women, who stubbornly insisted on their rights to go out, to spend money, even to leave their men when they so desired.35 It was, in contrast, the working-class men who used the ideal of the woman in the home to villify their victims. Guillais makes a strong case, but one should add a caveat in regard to extending her conclusions to all working women: for the women she discusses were mostly mur- dered. And as Guillais realizes, stressing the reasons why such women were killed entails now, as it did in the courtroom, a risk of blaming the victim for her own death; indeed, she notes the developing concept of the "penal couple" as a way by which defense attorneys could suggest that some victims were "predestined," by their interaction with their murderer, to be victims, a defense which led to some acquittals.36 Even irrefutable evidence of premeditation did not exempt an individual from a crime-of-passion defense: indeed, such planning would serve to indicate the individual's "obsession" with the victim. Though Guil- lais's discussion is not nearly so comprehensive as that of Harris, she nevertheless comes to the same conclusions: that psychiatry by the end of the nineteenth century had begun to undermine the principles of free will and responsibility which underlay the legal system, and that psychiatrists themselves, perhaps recognizing the dangers of such an approach, began to stress the necessity for self-control within the criminal, thus bringing back the ideas of free will and responsibility.

34 Guillais, Crimes of Passion, 22. See also Ann-Louise Shapiro, "Love Stories: Female Crimes of Passion in Fin-de-siecle Paris," Differences 3 (Fall 1991): 45-68; Benjamin F. Martin, The Hypocrisy of Justice in the Belle Epoque (Baton Rouge, La., 1984), for the Caillaux affair. For a comparative perspective on crimes between couples in Great Britain, see Nancy Tomes, "A 'Torrent of Abuse': Crimes of Violence between Working-Class Men and Women in London 1840-1875," Journal of Social History 1 1 (Spring 1978): 328-45.

35 Guillais, Crimes of Passion, 113. 36 Ibid., 69.




Another step in the conquest of new territory by alienists came with the law of 1838, viewed by Goldstein as one of the most significant steps in demarcating psychiatry as a profession. This law not only provided alienists with an institutional foundation in the creation of a nation- wide network of asylums, it also endorsed the therapeutic necessity of isolating the patient in the asylum under the physician's control. Un- fortunately, few new asylums were built until the late nineteenth century, and many of the asylums used by departments were clerical asylums. In addition, this law also authorized the retention of "mixed" nonspecialty rest homes.

While most recent works have focused on the intellectual history of the asylum in the nineteenth century, drawing largely from the writ- ings of prominent alienists, relatively few works have concentrated on the day-to-day operations of the institutions themselves.37 This task is undertaken in Yannick Ripa's Women and Madness: The Incarcera- tion of Women in Nineteenth-Century France.38 Ripa's study encom- passes the "golden age" of asylums, the period from 1838 to 1860. By 1860 the overflow of the asylums with excessive numbers of chronic patients had ended the reforming enthusiasm of the institutions, as alienists increasingly found themselves exercising custodial functions.39

Ripa regards the moral treatment as practiced by mid-century as inherently coercive: whereas Esquirol "was prepared to enter into the illusory world of the insane'" in ways reminiscent of the theatrical shocks of Pinel, others were not and simply insisted that their patients abandon their fantasies. Alienists became absorbed in the outward symptoms of behavior that signalled insanity, and patients quickly learned to hide such symptoms; what nineteenth-century doctors regarded as evidence of improvement might better be regarded as "self- control and repression." In Ripa's view, the moral treatment of most

37 Exceptions include Anne Digby, Madness, Morality, and Medicine; Laurence J. Ray, "Models of Madness in Victorian Asylum Practice," Archives europeennes de socio logie 22(1981): 229-64; Ellen Dwyer, Homes for the Mad: Life Inside Two Nineteenth-Century Asylums (New Brunswick, N.J., 1987).

38 A translation of La Ronde des folles: Femme, folie, et enfermement au XIXe sizle (Paris, 1986).

39 See also John Walton, "The Treatment of Pauper Lunatics in Victorian England: The Case of Lancashire Asylum, 1816-1870," in Madhouses, Mad-Doctors, and Madmen, 166-92, for a discussion of the de facto end of moral treatment in English asylums. For a discussion of the debate about the meaning of the asylum among historians of the United States, see Jamil S. Zai- naldin and Peter L. Tyor, "Asylum and Society: An Approach to Industrial Change," Journal of Social History 13 (Fall 1979): 23-48. Two of the central works on the history of insanity in the United States include David J. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic (Boston, Mass., 1971), and Gerald N. Grob, Mental Illness and American Society, 1875-1940 (Princeton, N.J., 1983).




alienists had been bankrupted by their resort to terror, as in the "moral revulsion" imposed by Esquirol's disciple Leuret.40

Asylums became the place where society's outcasts were placed: "The astronomical rise in the population of asylums was a measure, not of the level of insanity, but of the fear of the owning and ruling classes. . . . The law of 1838 was the death knell to all hopes of the possibility of integrating the insane into society; it was the end of the image passed down from antiquity of the madman as bearer of truths, the end of the idea of 'the village idiot'.' Here as elsewhere, the iniqui- ties visited upon the mad are attributed to the presumably monolithic "bourgeois mind," or the "unconscious mind of the authorities," and the reasons given for the committal of borderline cases are a way into that mind, "dissecting their hidden anguish and unveiling their hidden fantasies."42 The different schools of thought within the medical profession as well as the tug-of-war between the legal and medical professions over matters that touched both fields, so carefully described by Goldstein, Harris, and Robert Nye,43 are here reduced to a crude collu- sion among powerful men, all of whom had the same interests. In regard to women who became involved in political uprisings, for example, Ripa observed: "The alienists did not want to remain in the wings; they thought out a theory of political insanity, thereby giving those in power scientific backing. Both parties benefited: coercion became a form of therapeutic benevolence that was difficult to attack because madness remained hidden and taboo. . ..44

Ripa suggests that asylums may have acted as "social regulators" before political crises, serving as places to put rebellious women.45 She

40 Ripa, Women and Madness, 121-22. But F. Leuret was not typical and encountered significant criticism among his peers. Baruk noted that Leuret substantially redefined "moral treatment," transforming it from a "sentiment d'amour pour les d&sherites" into "une regle imperative, dogmatique, s'imposant par la force. . . . Believing that the insane was "un homme qui se trompe," he tried to bring him back to normal by intimidation, including, for example, icewater baths. Henri Baruk, La Psychiatriefranfaise dePinel a nos jours(Paris, 1967), 25. One of Leuret's patients, who claimed to be the son of Napoleon, was subjected to a dumping of buckets of cold water on his head, combined with severe reproaches, a treatment that continued until he recognized his error. Semelaigne notes that this treatment aroused considerable opposition among those who believed that intimidation should not be the basis of moral treatment. Seme- laigne, Les Pionniers de la psychiatric, 1:220-22. See also Robert Castel, "Le Traitement moral: Therapeutique mentale et contr6le social au XIXe siecle," Topique (1970): 109-29.

41 Ripa, Women and Madness, 12. 42 Ibid., 12-13. 4 Robert A. Nye, Crime, Madness, and Politics in Modern France: The Medical Concept of

National Decline (Princeton, N.J., 1984). 44 Ripa, Women and Madness, 23. 4 Ripa notes that only four of the women arrested after the Commune were sent to an asylum

and notes the same phenomenon in 1848: "Could it not rather be that the asylum was used by the police as one of their instruments of prevention rather than of repression, for which they preferred




also suggests that sexual politics within families shaped the population of the asylums, noting that more men than women committed female patients to asylums, while proportionately far more women than men tried to get female patients released. Therefore, "the fact that it was so often women who requested discharge from asylums confirms the fact that asylums were sometimes used by men to silence women."46

While her discussions of the politics of insanity tend to be oversim- plified into a battle of the sexes, Ripa is on firmer ground when discuss- ing the world of madwomen and their experiences of themselves as mad.47 She suggests that women in asylums often saw themselves as the wives or mothers of prominent individuals, noting that "the major cata- lyst of female fantasies at the time was the Duchess of Berry . . . as mother of a possible heir to the throne." They fantasized about the ad- vantageous marriages their daughters were about to make, though sometimes revealing the pathetically limited scope of their aspirations: Justine, a concierge married to a cobbler, was convinced that her daughter was about to marry the subprefect of Nantes.48

Ripa also adds significant insights to the conditions of life inside the asylums. Her physical descriptions of some of them, along with a discussion of their daily routines, and her explanations of typical kinds of treatments do provide considerable understanding of what it meant to be a patient. Anorexics were treated by a variety of forced-feeding tubes, stomach pumps, and gags. Physicians carried out "shock therapy" that was "often repression dignified by scientific language."49

imprisonment or deportation? . . . Thus, we can note that after the revolution of 1848 there was an unusual decrease in the number of committals; it fell from 7,686 admissions in 1847, to 7,341 in 1848. The figures showed a slight rise during 1849 to 7,536, and this was confirmed in 1850 (8,184 committals). The 'events' of 1870-71 also resulted in a noticeable reduction in the number of committals. It seems therefore that asylums acted as social regulators before a crisis but this can be no more than one hypothesis among others." Ibid., 29. The evidence seems less than compelling, however.

46 Ibid., 41. In Britain the fear of wrongful confinement of the sane led to the formation of the Alleged Lunatics' Friend Society. Peter McCandless, "Liberty and Lunacy: The Victorians and Wrongful Confinement," Journal of Social History 11 (Spring 1978): 366-86; the fear in this case concerned the greedy relatives out to grab the estates of heirs and heiresses. In France there was a campaign led by the liberal press in the late 1860s, which claimed that lunatic asylums endangered civil liberties, even doubling as political prisons. This campaign was awkward for asylum physicians, who had always seen themselves as part of the liberal establishment. Goldstein, Console and Classify, 352.

47 Relatively few works attempt to discuss madness as experienced by the mad. See, for example, Roy Porter, "'The Hunger of Imagination': Approaching Samuel Johnson's Melancholy," in The Anatomy of Madness, 1:63-88; Porter, The Social History of Madness; Dale Peterson, ed., A Mad People's History of Madness (Pittsburgh, Pa., 1982); Michael MacDonald, Mystical Bed- lam: Madness, Anxiety and Healing in Seventeenth-Century England (Cambridge, 1981).

48 Ripa, Women and Madness, 21. 49 Ibid., 131-32, and 123. By the 1870s, according to Nye, there was pessimism about the util-

ity of moral therapy for many of those in asylums; alienists used a variety of "physicalist" treat-




The shock treatment most frequently used was hydrotherapy. Women at the Salpetriezre were given showers on first being admitted, and at Charenton they were given baths, the length and water temperature de- pending on whether the inmate had been good or bad. In regard to this kind of treatment, in particular, it would be helpful to know if female patients were treated with therapies significantly different from those applied to males.50 And finally the asylum, as a kingdom of women ruled by male physicians, who held the power in the institutions, gave rise to "accusations of indecent assault, of sexual provocation or even of rape," which Ripa calls "an integral part of life in the asylum."5'

Most historians who have studied the evolution of asylums through the nineteenth century have stressed the pressure of overcrowding-when public asylums, in particular, became dumping grounds-as the reason why moral treatment gave way to simple custodial care.52 The professional dilemma of psychiatrists by the late nineteenth century namely, that they had effectively trapped themselves and their specialty in institutions so crowded that psychiatric care became impossible- has been discussed by other historians.53 Goldstein's account of the way

ments, including massage, electrotherapy, and hydrotherapy, though without having much faith in their utility for the mass of incurables who were "silting up" the asylums. Nye, Crime, Mad- ness, and Politics in Modern France, 229.

50 English asylums in the nineteenth century, many of them committed to the "non-restraint" method, used seclusion, the shower, accompanied by an emetic, or the "wet-pack"-a wet sheet wrapped around the patient-to restrain those patients who were violent. Though national varia- tions in the care of insanity persisted, such treatments in France may not have been done mali- ciously, but rather carried out as a substitute for chains or the tranquilizers of today. Nancy Tomes, "The Great Restraint Controversy: A Comparative Perspective on Anglo-American Psychiatry in the Nineteenth Century," in The Anatomy of Madness, 3:198.

51 Ripa, Women and Madness, 145. However, Ripa relies heavily on the memoirs of Hersilie Rouy, a woman who was wrongfully incarcerated and spent many years trying to get out. As a cautionary note, Evans has noted that Rouy, eager to blacken the asylums, did not mention incidents of sexual assault. See Martha Noel Evans, Fits and Starts: A Genealogy of Hysteria in Mod- ern France (Ithaca, N.Y., 1991), 45. A discussion of Hersilie Rouy's Memoires d'une alienee (Paris, 1883) can be found in Jeffrey Moussaieff Masson, Against Therapy: Emotional Tyranny and the Myth of Psychological Healing (New York, 1988), 14-26.

52 Dr. Henri Rech of Montpellier, a student of Esquirol and a firm believer in moral treatment, complained as early as 1833 that the cure rate was so slow that he had only incurables filling his asylum. Colin Jones, "The Treatment of the Insane in Eighteenth- and Early Nineteenth- Century Montpellier," Medical History 24 (1980): 389.

53 See, for example, LaurenceJ. Ray, "Models of Madness in Victorian Asylum Practice," Ar- chives europeennes desociologie 22 (1981): 259, whoclaimed that after the 1860s, British psychiatrists shifted into "medico-legal work, private practice, working with research foundations, and university teaching and research, all of which were more prestigious than asylum management." Scull also notes that British asylum psychiatrists tended more and more to immerse themselves in administrative work, thus isolating themselves from the patients as much as possible; the dirty, day-to-day work was done by a low-paid staff. Andrew T. Scull, "Mad-Doctors and Magistrates: English Psychiatry's Struggle for Professional Autonomy in the Nineteenth Century," Archives europeennes de sociologie, 17 (1976): 298-99.




out of that dilemma takes particular note of hysteria, one of the most "popular" nervous diseases of the late nineteenth century. For Gold- stein, the rise of hysteria as the disease of choice in the Third Republic was another successful sortie by psychiatrists, who were aiming this time not at the legal profession but rather at other physicians who had taken over "nervous" diseases-diseases, in other words, that were not full-blown cases of insanity but rather allowed their victims to continue to live in society. And that was precisely the point: nervous diseases such as hysteria and neurasthenia,54 the other great affliction of the "in- termediary zone," could often be treated in the doctor's office and thus provided an escape-for psychiatrists this time-from the asylum. Neurotics as well as psychotics now fell into the domain of the alienists. Out-patient treatment, currently the dominant form of therapy, became possible, and the asylum slipped out of the psychiatric spotlight and back into the nether regions it had once occupied, an institution again devoted more to incarceration than to cure.

Hysteria, however, has long been a controversial and problematic disease for many contemporary historians. It has frequently (and per- suasively) been viewed as an example of male exploitation and exagger- ation of the supposed character of women in the nineteenth century or, alternatively, as a way in which women could command power and influence within the household. 55 Jean-Martin Charcot, at the Salpetrie're from 1862 to 1893, established a descriptive paradigm for the disease. An attack of grande hysterie, according to Charcot, went through four distinct phases,56 each of which he documented in extensive photo-

54 In the United States, according to Barbara Sicherman, neurasthenia was used by the new specialty of neurology against the claims of the alienists, because the diagnosis provided a physical reason-exhausted nerves-for a disease that might otherwise fall into the province of psychiatry. Barbara Sicherman, "The Uses of a Diagnosis: Doctors, Patients, and Neurasthenia," Journal of the History of Medicine and Allied Sciences 32 (1977): 33-54.

55 See Carroll Smith-Rosenberg, "The Hysterical Woman: Sex Roles and Role Conflict in l9th-Century America," Social Research 39 (Winter 1972): 652-78. The young Freud overheard a conversation between Charcot and Brouardel about hysterics, in which Charcot remarked:

'Mais, dans des cas pareils, c'est toujours la chose genitale, toujours . . . toujours . . . toujours ...'" Freud continued, "Ce disant il croisa les bras sur sa poitrine et se mit a sautiller avec sa vivacite habituelle. Je me rappelle etre reste stupefait pendant quelques instants et, revenu a moi, m'etre pose la question: Puisqu'il le sait, pourquoi ne le dit-il jamais?" Sigmund Freud, "Contribution a ihistoire du mouvement psychanalytique," Cinq Le~ons sur la psychanalyse, trans. Jankelevitch (Paris, 1936; ed. 1968), 78, cited in Didi-Huberman, Invention de l'hysterie: Charcot et l'iconographie photographique de la Salpetriere (Paris, 1982), 160. One of the instruments in use in the Salpetriere for stubborn cases was an "ovarian compressor," an instrument of mild torture whose underlying presumptions were obvious. Evans, Fits and Starts, 26.

56 The four phases were "(1) tonic rigidity; (2) clonic spasms or grands mouvements,. (3) attitudes passionnelles, or vivid physical representations of one or more emotional states, such as terror, hatred, love; . . . (4) a final delirium marked by sobs, tears, and laughter and heralding a return to the real world." Goldstein, Console and Classify, 326. See also Jan Goldstein, "The Hysteria Diagnosis and the Politics of Anticlericalism in Late Nineteenth-Century France," Jour- nal of Modern History 54 (June 1982): 209-39, for an earlier version of this argument.




graphs of his patients, often half-clothed and frequently in suggestive poses.57 Augustine, a fifteen-year-old hysteric who had arrived in the asylum after having been raped, became his star patient and model.58 Though the photographs were published and widely circulated, Charcot was even more famous for his Tuesday lessons, open to the public, in which he displayed actual hysterics in various phases of their attacks.

Indeed, for those seeking evidence that psychiatry was imposed by men to silence women, Charcot is so perfect an oppressor that one could not have invented a better one.59 An authoritarian personality, he did not like being interrupted and would quiet patients if they talked too much. "You hear how hysterics shout," he once reportedly said, "much ado about nothing."60 Charcot liked to triumph, proudly re- counting to his colleagues his victory over a fourteen-year-old anorexic who had made him the following confession: "Since I had a horror of eating, I didn't eat. But when I saw that you were the master, (italics added), I was afraid, and in spite of my repugnance, I tried to eat."96'

The fact that most of Charcot's patients were usually women as well as members of the working class inevitably affected the interpretation of the ailment, despite Charcot's own efforts to stress the fact that men-largely lower-class men-were also stricken.62 Even in his own day, Charcot's professional behavior-not only the Tuesday sessions but also the photographs taken of his patients, in which no attempts were made to hide the identity of the patients involved-raised ethical

57 Didi-Huberman notes that the Salpetriere, in addition to its photography lab, also had fa- cilities for making plaster casts of hysterical contractions, especially the hands and feet, butalso on occasion the torso. Georges Didi-Huberman, Invention de l'hysterie, 122-24.

58 Showalter, The Female Malady, 152-54. According to her own story, Augustine had been raped at the age of thirteen by her mother's lover. She was in the Salpetriere for five years, becom- ing so violent that she was locked in a cell. She disguised herself as a man, escaped, and disap- peared entirely from view. For a discussion of Augustine, Charcot, and the fin-de-siecle culture, see Charles Bernheimer, Figures of Ill-Repute: Representing Prostitution in Nineteenth-Century France (Cambridge, Mass., 1989), 252-59.

59 At the same time, Charcot, who held the newly created (by Gambetta) chaire des maladies du systeme nerveux, revitalized the old institution with the construction of an out-patient clinic and a number of medical and scientific laboratories. He also developed it into a preeminent teaching institution. Mark S. Micale, "The Salpetriere in the Age of Charcot: An Institutional Perspec- tive on Medical History in the Late Nineteenth Century," Journal of Contemporary History 20 (October 1985): 709.

60 J. M. Charcot, L'Hysterie, ed. E. Trillat (Toulouse, 1971),119, cited in Showalter, The Fe- male Malady, 154.

61 Evans, Fits and Starts, 37. She notes that Gilles de la Tourette, one of Charcot's disciples, claimed that this had been said to him.

62 J M. Charcot, Le~ons du mardi a la Salpetriere, 1888-1889, 17th lesson, 12 March 1889, n. p., cited in Gerard Wajeman, Le Maitre et l'hysterique (Paris, 1982),125. Male hysterics, however, were "sombres, mrlancholiques, d&primes, d&courag&s." Semelaigne, Les Pionniers de la psychiatric fran~aise, 2:119.




questions about confidentiality and privacy.63 He was subject to an increasingly serious attack from a contemporary rival, Dr. Hippolyte Bernheim of Nancy, who disagreed with him on his interpretation of hysteria and-more surprisingly-on his view of hypnosis. As Harris has clearly shown, the dispute between Charcot and Bernheim over hypnosis was not a marginal debate but a fundamental one over the issue of suggestibility. The Charcot school believed that only those already "hysterical" would be susceptible to hypnosis, the technique in this case serving to unlock symptoms and behaviors that were already there (and that, consequently, should only be unlocked by specialists in mental maladies). Members of the Bernheim school, however, though believing hypnosis a useful therapy for many kinds of patients, nevertheless worried that hypnosis might reduce the will of the victim to nothing, allowing the hypnotist to force her to commit acts against her will. Several court cases hinged on this defense.64 More prosaically, any woman might be menaced by "the working-class hypnotizer-rapist," a phantom conjured up by the alarmism of Dr. Jules Liegeois of the Nancy school, who noted that the cunning attacker might also implant a suggestion of amnesia about such an incident in the mind of his victim. His suggestion was "moral vaccination," or a hypnotic suggestion implanted in "nervous" women for their own protection.65

In regard to hysteria itself, the Nancy school concentrated on the role of ideas, "on mental suggestions, in transforming physical states." As Harris has noted, Bernheim did not ignore the significance of such physical influences as heredity but came to emphasize the effect of mental influences on the physical. Bernheim blamed Charcot for creating a hysterical "epidemic" out of his own mind and noted to Charcot that nowhere else on the continent or elsewhere were the "four stages" of hysteria visible. He accused Charcot of influencing his patients by suggestion and asserted that what Charcot had created was une hysterie de culture, produced by his own suggestions and by his willingness to let himself be duped.66

63 L'Iconographie de la Salpetriere appeared under the auspices of Charcot, in 1876, 1877, and 1880; the Nouvelle Iconographie de la Salpetriere appeared in 1888. Didi-Huberman, Inven- tion de l'hysterie, 47-50. Photography began to be applied to the study of the insane in the early 1850s; Hugh W. Diamond, a superintendent of the Surrey County Lunatic Asylum, presented a paper on the subject to Britain's Royal Academy in 1856. Sander L. Gilman, Seeing the Insane (New York, 1982), 164.

64 Gilles de la Tourette, one of Charcot's disciples, stated on the contrary that under hypnosis subjects would not do something that went against their own nature. Harris, Murders and Mad- ness, 168, 181-84. See also Ruth Harris, "Murder under Hypnosis in the Case of Gabrielle Bompard: Psychiatry in the Courtroom in Belle Epoque Paris," in The Anatomy of Madness, 2:197-241.

65 Harris, Murders and Madness, 186, 190. 66 For a discussion of the rivalry between Bernheim and Charcot, see Harris, Murders and




By the late nineteenth century, the issue of appearance and reality had assumed a place of central importance in the professions. Alienists increasingly asserted that insanity might be visible only to the "clinical eye" of the physician. As Skultans has noted, by the late nineteenth century physicians were constantly on guard for "early warnings" of in- cipient madness.67 While genuine insanity might be "masked" in apparently normal individuals, however, there was also a fear that hysterics, and especially female hysterics, might resort to duplicity in order to gain attention. Even some followers of Charcot worried that they might be taken in by feminine theatrics, and so they resorted to dubious methods-electric shocks, sudden frights, spying on patients by attendants-to try to startle hysterics into honest behavior.68

The fear of female deception was in part responsible for the dis- crediting of much of Charcot's work, which began to be subjected to severe criticism as soon as he was safely under the ground. Dr. Joseph Babinski, one of Charcot's disciples, began after the master's death to "dismantle" his theories, basing his own studies on the assumption that women were shamming. The women at the Salpetriere, he claimed, were "professionals"; their hysterical symptoms were "illusory constructs" that the doctor would have to master.69 He created a new term for hysteria, pithiatism (later supplemented by mythomania). Ironically, this mistrust of women had a greatly adverse affect on men.

Madness, 171-93. Georges Guillain, an intern at the Salpetriere a few years after Charcot's death, suggested that Charcot's underlings "prepared the patients, hypnotized them, and organized the experiments. Charcot personally never hypnotized a single patient, never checked the experiments. . . ." He added that the attendants had concluded that they "did not dare" alert Charcot. Georges Guillain, J.-M. Charcot 1825-93: His Life-His Work, trans. Pearce Bailey (New York, 1959), 174-76, cited in Thomas S. Szasz, The Myth of Mental Illness (New York, 1961), 33-34.

67 Vieda Skultans, Madness and Morals: Ideas on Insanity in the Nineteenth Century (Lon- don, 1975), 22.

68 Thus Freud's well-known dislike of Dora was not a dislike of her alone. Physicians felt ambivalent about these cases and above all wished to prevent patients from gaining a sense of power through their disease; thus the frequent concern over who was "master." See Hannah S. Decker, "Freud and Dora: Constraints on Medical Progress," Journal of Social History 14 (Spring 1981): 450-52.

69 See Evans, Fits and Starts, 55-56. The women also copied their attacks from each other and were further guided by physicians who knew what they expected to diagnose. Such a theory ac- counted for the "epidemics" of hysterical attacks that could occur in the hospitals but also, Ba- binski suspected, could account for seemingly spontaneous and untaught attacks that might occur in town: "telle jeune fille, qui semble creer une attaque d'hysterie, a eu loccasion de voir quelque personne sujette a des troubles semblables et ne fait que reproduire ce quelle a observe. I1 est assez vraisemblable quil en est toujours ainsi quand la premiere crise est deja bien caracterisee. Une emotion vive, une colkre, peut sans doute, en dehors de toute suggestion ou d'auto-suggestion provoquer une constriction de la gorge, des contractions musculaires, de l'obnubilation intellec- tuelle, mais ce ne sont la que des phenomenes en quelque sorte physiologiques; si on les denomme hysteriques, cest de l'hysterie fruste qui ne deviendra parfaite que sous linfluence de la suggestion inconsciente des personnes de lentourage et des examens medicaux. Joseph Babinski, Suggestion et hysterie (Chartres, 1907), 13, cited in Wajeman, La Maitre, 185.




During World War I, French physicians, under the influence of Ba- binski's ideas, subjected "shellshocked" French soldiers to massive electrical currents (a technique described as torpedoing) and other brutal treatments designed to shock them out of their supposed ruses.70

It was probably Michel Foucault's brilliant Folie et deraison: Histoire de lafolie a la'ge classique that first captured the imagination of many contemporary historians of madness. The book turned inside out many previous "'march of progress" histories of psychiatry and made villains out of heroes. Foucault underlined the forbearing attitude of those of the medieval and early modern period, who, though not always toler- ant of the mad among them, had nevertheless not severed them from humanity.7' He argued that the "Great Confinement," which took place roughly between 1660 and 1800, marginalized and sequestered mad people as well as assuming them to be brutes, in no need of cloth- ing, insensible to cold and heat-a sort of madness whose face was that of Theroigne de Mericourt, as described by Esquirol. Forced inside with vagabonds, beggars, and criminals, lunatics were turned into spectacles, as thousands came to visit the great madhouses of Europe. At the beginning of the nineteenth century, the moral therapy of Pinel and others, although far gentler physically, nevertheless simply substi- tuted a new kind of coercion for the external physical restraints of the classical age. The mad were subjected to a discipline that was designed to force them to internalize the norms of rationality and labor required by the emergent capitalist society.

Sadly, it is necessary to give up many of Foucault's most startling images: his assertion of a literal Ship of Fools, for example, as well as the ninety-six thousand paying visitors to Bedlam every year. Nor did madmen wait until the "great confinement" to be locked up, because attempts, many of them religious and charitable, had been made to con-

70 After the war, Georges Dumas, in an article in 1923, suggested drawing the distinction between genuine hysterics, and "mythomaniacs" (his suggested term), or those who used their symptoms to gain attention and resisted efforts to cure them; he wrote in response to the hysterics of World War I soldiers. Evans, Fits and Starts, 84, has a discussion of the genesis of this treatment in the work of Babinski. See also Showalter, The Female Malady, 167-94, for a discussion of the very different, and kinder, treatment accorded to British soldiers; and Martin Stone, "Shellshock and the Psychologists," in The Anatomy of Madness, 2:245, 247, who argues that shellshock and its treatment, while doing much to discredit the psychiatric establishment, nevertheless led to an in- creased acceptance of outpatient treatment and an expansion of the ailments included in "mental medicine."

71 Michel Foucault, Folie et deraison: Histoire de la folie ia 1'dge classique (Paris, 1961), 10-16. Foucault's description of the treatment of the mad in the Middle Ages is not so lyrical as it is sometimes portrayed; he described particular incidences of madmen sent away on boats, (p. 1 1), as well as information concerning those thrown into prisons.




fine them at least as early as the fifteenth century. The process of a large- scale "great confinement" was not a European-wide phenomenon; even in France itself it may not have been as extensive as Foucault has suggested, and it was not the poor alone who made up the small number of people who were locked up as mad.72

The underlying implications of Foucault's work for social class- that psychiatry represented the desire of the bourgeoisie to repress the poor-have for a long time set the terms of the debate, even among those who do not subscribe to that interpretation. But as the authors of the recent works discussed here have suggested, gender is also a critical aspect of the situation. Women might well have been more easily locked up, more easily brushed aside, than men. Theroigne de Mericourt at- tempted to get out of the madhouse several times, for example, in her letter to Saint-Just and in her petition to authorities in 1794. During her stay in the madhouse of the faubourg Saint Marceau in 1795, she at- tracted the attention of a neighbor by shouting out of the window, and he was sufficiently impressed by her appeal to question the authorities about her. The last known trace of her activity on her own behalf occurred in 1800, when she was transferred out of the Salpetriere into the Petites Maisons. There is a tragic irony in her last exertion, for Pinel, at the Salpetriere since 1795, began a large-scale quantitative study of patients' responses to his new methods in about 1800-just when Theroigne had demanded, and received, a transfer away from him. It is not at all certain that she would have been included in Pinel's sample, even had she been present, because Pinel eliminated from his study those long-term cases whose cure seemed unlikely. Nevertheless, her close brush, relatively early in her madness, with the greatest psychia- trist of the era lends additional poignancy to her last years. Esquirol noted that by 1810 (he took over in 1811) she had become "calmer"- not an improvement, for she "had lapsed into a state of dementia."73 And there were other Theroignes, similarly forgotten at the Salpetriere later in the century. Georges Guillain, a medical intern at the Sal- petriere just after the days of Charcot, later remembered the "excellent

72 Among historians who have challenged Foucault on specific issues are Sedgwick, Psycho Politics, 125-48; H. C. Erik Midelfort, "Madness and Civilization in Early Modern Europe," 247-65; and Roy Porter, Mind-Forg'd Manacles, 1-15, 117-19. Patricia Allderidge notes that the admission of visitors to Bethlem, or Bedlam, was ended in 1770, and that visitors were not "charged" so much per head but rather made donations as they left. As for the 96,000 visitors per year, she suggests-that historians think about just how many visitors that would have meant per day in the asylum; the figure came from assuming the annual "take" of Bedlam at a fixed rate per viewer. "Bedlam: Fact or Fantasy," in The Anatomy of Madness, 2:17-33.

73 Roudinesco, Theroigne de MWricourt, 171.




comedians" among the older chronic patients who had spent their lives in the wards: when offered money, he said, they would "[imitate] per- fectly the major hysterical crises of former times." For such women, the asylum had indeed become a prison.74

74 Guillain, J.-M. Charcot 1825-93: His Life-His Work, 174, cited in Evans, Fits and Starts, 41, who discusses the implications of long-term institutionalization rather than care for these women.

