Mad, Bad and Sad: A Historical Romance

Lisa Appignanesi’s book Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present is a romantic tour through the last 200 years of psychiatry and the feminine, although probably not in the sense you’re thinking of.

The romantic movement was a literary and artistic phenomena that emerged in the 1800s as a backlash to the rationalism of the enlightenment. They railed against science as a dehumanising force, although this view was not its most lasting legacy.

Perhaps the biggest impact of the romantic movement was to seed the idea that the scientific and the humane were contradictory and incompatible, suggesting that it is not possible to be both scientific and compassionate, rational and poetic, or objective and understanding at the same time.

These are the two cultures, of which C. P. Snow famously spoke, and applied to the mind the romantic view suggests that an interpretative psychology touches the very core of our humanity, whereas the empirical barely scratches the surface.

It’s a false dichotomy because we are neither the facts of biology nor the feelings of the mind. We are at all times, both. Each is just a shadow of the whole that, paradoxically, has no single identity.

The colours of romanticism run through Appignanesi’s book, who hails from a cadre of the feminist literati who have become respected psychoanalytic thinkers. As she notes in her book, heavyweights like Julia Kristeva and Juliet Mitchell were literature PhDs before training as analysts, and although Appignanesi maintains a critical distance, the same vein runs through her work.

This is most apparent in her explorations of the lives of famous women who have shaped our ideas about the feminine and mental illness. It is Freudian literary analysis which forms the backbone of personal explanations in the book, as each person’s inner life is poetically explored without significant recourse to other ways of interpreting their motivations and desires.

It is also the case, however, that this period of history is the most gripping of the book, not least because it features the players for which Appignanesi has the most passion, but also because of her careful historical work, weaving the developments in the understanding of the mind to the social, to the personal, and back again.

But it is not the focus on the poetic psychologies that gives the book its romantic tone, so much the coldness for science which most clearly shows itself as the book rolls on to the present.

This is partly reflected in the numerous minor neglectful errors that pop up in the final section: atypical antipsychotics are described as have ‘far fewer side-effects’ than the older types when we’ve known this not to be the case for many years; the ‘diazepams’ are described as a drug class when diazepam is a single specific medication; cognitive therapy is described as being based on an ‘underlying assumption that people are rational beings and ever-capable of self-assessment, without any self-deception’ when it is based, and always has been, on exactly the opposite premise.

With this section also comes unconcealed hostility for new evidence-based methods of mental health: psychometric tests are dismissed as ‘fun as parlour games’, cognitive therapy is bizarrely accused of being akin to ‘brainwashing’ and standardised questionnaires as pathologising teenagers.

The fact that these could be the effective tools of humane and sensitive clinicians seems almost impossible in this light. The rise of science in psychological treatment is portrayed as antagonistic to empathy and the true work of understanding the soul, when, in fact, they are complementary to it.

The likes of Elaine Showalter’s Hystories does not share this romantic slant, and manages to remain more broad in its overview, although is more limited in its scope.

But despite the slant, I found Mad, Bad and Sad both powerful and enlightening, gripping in places, and compelling in many of its arguments.

It is perhaps, the best romantic history of psychiatry available, although, it is not as purely historical as it claims.

Link to book details.

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