Flesh in the Age of Reason (48 page)

The somatic theories of madness popular early in the eighteenth century promised therapeutic interventions. After all, if insanity arose from organic disease, would it not – like other organic maladies – be responsive to physical treatments? Hence various drug ‘cures’, like camphor, came into vogue, some designed to sedate maniacs, others to invigorate melancholics; opium was freely prescribed for both purposes! There were also physical treatments like blood-lettings, emetics and violent purges to discharge toxins; shock treatments like
cold showers, baths and douches; new technological fixes like electric shocks, rotatory chairs and mechanical swings, designed to disrupt
idées fixes
; and, when all else failed, mechanical restraints like chains and straitjackets, designed to quieten maniacs. William Perfect, keeper of a private madhouse in Kent, deployed upon his patients a battery of physical techniques, designed to tranquillize the delirious. He had recourse to opiates, solitary confinement in darkened rooms, cold baths, a ‘lowering’ diet, blood-letting, purgatives and so on. These would pacify the body, so as to render the mind more receptive to reason.

In the latter part of the century, hope came to be vested in the therapeutic potential of the madhouse itself. The asylum’s segregative environment was tailor-made for the new psychiatric techniques of mastering madness, aimed at overpowering the delinquent will and passions. Moreover, as the inadequacies of drugs became plain, and with humane critics condemning use of manacles and whips as cruel and counter-productive, the well-run asylum commended itself as the ideal site of therapy for an enlightened age.

Europe’s oldest madhouse, Bethlem Hospital, founded in 1247, made trifling attempts to put its house in order. But inertia was the bone of contention in the skirmish between John Monro, its physician, and William Battie, the founder of St Luke’s, a new London charitable asylum. In 1758 Battie’s
Treatise on Madness
blamed Bethlem for its backwardness: it was insular, it failed to teach students, it used discredited remedies. His honour impugned, Monro retaliated in the same year with
Remarks on Dr. Battie’s Treatise on Madness
.

In his book, Battie stressed the value of early confinement in asylums where the accent should lie upon
management
. Management would achieve more than medicine, he stressed, in a phrase which became the shibboleth of progressive psychiatry in Britain. His division of madness into ‘original’ (congenital) and ‘consequential’ (acquired) was also attractive. Following Locke, he believed that ‘deluded imagination’ was the essential feature of consequential madness and that it could be cured by timely confinement.

The new outlooks arising after 1750 in which madness was increasingly
viewed as a psychological condition, the result of bad habits and misfortunes, required a new psycho-therapeutics. The solution evidently lay in managing the mind. Dr William Pargeter, for instance, placed his faith in a kind of psychodrama between maddoctor and patients. ‘When I was a pupil at St. Bartholomew’s Hospital employed on the subject of Insanity,’ he reported of one of his cases,

I was requested… to visit a poor man… disordered in his mind… The maniac was locked in a room, raving and exceedingly turbulent. I took two men with me, and learning that he had no offensive weapons, I planted them at the door, with direction to be silent, and to keep out of sight, unless I should want their assistance. I then suddenly unlocked the door – rushed into the room and caught his eye in an instant. The business was then done – he became peaceable in a moment – trembled with fear, and was as governable as it was possible for a furious madman to be.

What Pargeter describes seems a little like a secular version of exorcism. Not every late-eighteenth-century mad-doctor, of course, exercised charisma in such a theatrical, almost Mesmeric, manner. But common to most was the belief that madness was curable, to be treated through person-to-person encounters and psychological expertise.

The contemporary term for this new psychological strategy was ‘moral management’ – ‘moral’ in the sense of addressing itself to the patient’s mind, rather than merely to the body, establishing a consciousness-to-consciousness rapport; ‘management’ because the mad-doctor had to prove dynamically resourceful and inventive in initiatives designed to impose discipline. The Manchester physician John Ferriar stressed that humanity must replace brutality, and moral treatment had to supplant physical. ‘The management of the mind’, he explained, ‘is an object of great consequence, in the treatment of insane persons, and has been much misunderstood. It was formerly supposed that lunatics could only be worked upon by terror; shackles and whips, therefore, became part of the medical apparatus.’ ‘The chief reliance in the cure of insanity must be rather on management
than medicine,’ explained Pargeter for his part. ‘The government of maniacs is an art, not to be acquired without long experience, and frequent and attentive observation.’ The new psychiatrists condemned a ‘dark age’ when lazy approaches to madness – whether soporific draughts or chains – had prevailed. No eighteenth-century ‘moral manager’ dogmatically dismissed physical coercion and constraint. But such methods came to be regarded as, at best, necessary evils, commonly over-used and abused. ‘Here’, enthused Benjamin Faulkner about his own private madhouse, ‘all unnecessary confinement is avoided.’

Moral management radically altered treatment of the insane, and thereby changed the shape of discourse about madness. Traditionally, writings concerning insanity had been philosophical, religious, anato-mico-medical or classificatory. In a new genre rising to prominence towards 1800, close observation of the everyday behaviour of the insane became the great priority, and the course of the disorder under treatment was charted. For the first time, the criterion for proper knowledge about madness became the close encounter with patients under confinement.

How was the mad person to be regarded? Mental disorders sparked much public debate during the ‘age of reason’: why had the progress of civilization apparently led to the increase of mental instability and suicide? Under a variety of terms – hypochondriasis, the vapours, the spleen, melancholy and low spirits – what later came to be known as the ‘neuroses’ – were said to be particularly prevalent among the English, whose climate, affluence and fashionable lifestyles supposedly produced what George Cheyne styled the ‘English malady’. ‘Refined sensibilities’ were said to be most susceptible and, in the new ‘age of feeling’, members of polite society might pride themselves upon ‘hypochondriack’ or ‘hysterick’ disorders, as signs of their superiority. Hysteria became a fashionable diagnosis among doctors faced with bizarre and unpredictable symptoms in their female patients – pains in the genitals and abdomen, shooting from top to toe, or rising into the thorax and producing constrictions around the throat (the ‘
globus hystericus
’), twitchings, tics and spasms, seizures and
paralyses. According to the neurological pioneer Thomas Willis, ‘when at any time a sickness happens in a Woman’s Body, of an unusual manner, or more occult original, so that its causes lie hid, and a Curatory indication is altogether uncertain… we declare it to be something hysterical… which oftentimes is only the subterfuge of ignorance’. Enlightened physicians too professed bafflement at the Sphinxian-riddles of psyche–
soma
affinities. The notable clinician William Heberden was hesitant to seem dogmatic as to the root-causes of such conditions, for ‘hypochondriac and hysteric complaints seem to belong wholly to these unknown parts of the human composition’. In a society in which ‘distinction’ counted, illness, as we saw in
Chapter 13
, could be a treasured resource and, at least in the form of ‘the hyp’ and hysteria, mental illness could stake a claim to attention or even fame. ‘
We Hypochondriacks
’, declared Boswell, ‘console ourselves in the hour of gloomy distress, by thinking that our sufferings mark our superiority.’

George
III
’s ‘madness’ dramatically drew attention to mental disorders; and the fact that the ‘mad king’ recovered from his incapacitating attack of 1788–9 bred optimism. Together with the ‘convulsion’ of the French Revolution, the madness of King George points to enigmatic connexions between the age of reason and the prevalence and comprehension of insanity. The close of the century nevertheless brought a remarkable synthesis between new psychological thinking and reformist practice. This was ‘moral therapy’, a movement associated with the humane management of asylum patients.

One pioneer was the Florentine physician Vincenzo Chiarugi, whose ideas were set out in a major three-volume treatise,
Della Pazzia
(On Madness: 1793–4). In France, the physician Philippe Pinel was the leading advocate of the new approach, condemning harsh therapies and recommending close observation of the patient. In 1793 he was placed in charge of the Bicêtre, the main public madhouse in Paris for men, becoming head of its female equivalent, the Salpêtrière, two years later. His celebrated striking off the chains from his patients is probably mythical. Nevertheless, the cumulative impact
of his careful work at the Bicêtre and Salpêtrière was considerable, and his
Traité médico-philosophique sur l’aliénation mental ou la manie
(1801) described the path by which he came to his ideas on the moral causation and moral treatment of insanity.

Such developments were paralleled in England by the founding of the York Retreat in 1796, set up after the mysterious death of a Quaker patient in the York Asylum. Partly by religious conviction, partly by practical trial and error, it was to evolve a distinctive therapeutics grounded on quiet, comfort and a supportive family atmosphere in which the insane were to be treated like ill-behaved children. Its success was publicized by Samuel Tuke’s
Description of the Retreat
(1813), which offered a shining model for early nineteenth-century reformers.

As with Pinel, in England moral therapy was justified on the twin grounds of humanity and efficacy. The Retreat was modelled on the ideal of family life, and restraint was minimized. Patients and staff lived, worked and dined together in an environment where recovery was encouraged through praise and blame, rewards and punishment, the goal being the restoration of self-control. The root cause of insanity, be it physical or mental, mattered little. Though far from hostile to doctors, Tuke, a tea-merchant by profession, stated that experience proved that nothing medicine had to offer did any good.

What do these changing models of madness tell us about attitudes to reason and the irrational in the move to modernity? If images of the insane may be read as projected negations of cherished ideals of humanity, it is clear that, back in the seventeenth century, anxieties ran deep that the Christian must be decisively demarcated over and against the brute kingdom (‘inferior animals’) on the one hand and the damned on the other. In an age of secularization, when those particular fears waned, the attributions of madness to bodily disorders subsequently proved a strategy for preserving the mind free from the taint of madness, an important dignifying and exculpatory strategy. In time, however, the prevalence of Lockean outlooks undermined the rigid polarity between the sane and the mad (the difference lay
only in proper and false associations of ideas). This strategy no longer caused terror because first the fashionable cults of individualism and sensibility and then later Romanticism permitted a new pluralism and permissiveness in the sane while enlightened optimism held out hope that the insane were genuinely curable, perhaps in those new lunatic asylums which were promoted as resembling the new bourgeois vision of heaven.

There is no question of importance, whose decision is not
compriz’d in the science of man; and there is none, which
can be decided with any certainty, before we become
acquainted with that science.

DAVID HUME

The Enlightenment gave birth or favour to many sorts of ‘men’. There was, for example,
homo faber
, man the maker, the harbinger of technological man; and his cousin,
homo faber suae fortunae
, man the maker of his own fortune, that Baconian model of the progressive individual, the Robinson Crusoe figure. Perhaps the most famous, however, is
homo economicus
, economic man, indelibly associated with Adam Smith’s
Wealth of Nations
.

All these, however, were subordinate to the ‘Man’ who was the object of that science of human nature so energetically pursued by the enlightened. In an essay of 1741, David Hume proposed that politics should be reduced to a science. Something of the sort had been a goal at least since Newton, in the Queries appended at the end of his
Opticks
, had indicated the road ahead: ‘And if natural Philosophy in all its Parts, by pursuing this Method, shall at length be perfected, the Bounds of Moral Philosophy will be also enlarged.’ Sir Isaac thus entertained the prospect of the elucidation of human nature grounded upon natural science, and that was a goal especially pursued by the Scots but by none more so than by David Hume, who aspired to become the Newton of the ‘moral’ – that is, human – sciences. What Hume meant by ‘the science of man’ was a public and principled search for human nature, a science independent of
received authority and the
ex cathedra
pronouncements of the Churches. But it was also the outgrowth of his own personal odyssey.

Born in Edinburgh in 1711, Hume inherited a patrimony which guaranteed him modest financial independence. During the course of half-hearted attempts to launch a career in trade and then the law, both of which he found unpalatable, the young Hume developed the aspiration to be
homo philosophicus
. Was this not a noble ambition? After all, had not the very act of philosophizing, in the great Stoic tradition, been the declaration of rational autonomy, the quest for true philosophical ‘apathy’, that is, aloofness from the trivia of the workaday world? What a disaster, then, for a philosopher to fall sick and thus not to liberate, but to disorient, the mind? That was precisely Hume’s fate.