Mad, Bad and Sad

Lisa Appignanesi

4 ideas

1. Mary Lamb kills her mother, 1796

   In September 1796 Mary Lamb, in a fit of mania, stabbed her mother to death with a table knife at the family's London home. She was judged lunatic rather than a murderer. Instead of lifelong asylum confinement, she was released into the private care of her brother Charles, with whom she co-wrote 'Tales from Shakespeare' while living through recurrent attacks and periodic stays in private madhouses. The case shows that, before institutional psychiatry took hold, family custody and intermittent care could make a violent episode survivable and still leave room for a productive life.

2. Mad, bad, or sad is a shifting boundary

   The same behaviour can be classed as madness (a medical problem), badness (a moral or criminal one), or sadness (ordinary suffering). Where the lines fall depends on the period's legal rules, medical theories and gender expectations. Asking which of the three categories an era assigns to a woman's distress shows who gains authority over her: the doctor, the judge, or nobody.

3. Diagnoses rise and fall like fashions

   Women's mental distress takes the forms that its culture and its doctors are ready to recognize. That is why hysteria, neurasthenia and 'nerves' later gave way to anorexia, multiple personality, depression and borderline disorder. Each label becomes popular, spreads through publicity and clinical enthusiasm, and fades. The suffering underneath may persist while its visible symptoms change to match the available categories.

4. Illness co-produced by doctor and patient

   A psychiatric presentation is partly created by the relationship between the doctor and the patient. The patient's symptoms respond to the physician's theory, attention and expectations. Charcot's hysterics at the Salpêtrière, for example, performed textbook attacks at his public demonstrations. The doctor's framework does more than describe the illness: it gives the patient a script, and the way she displays her distress follows it.

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