Life of the mind: a degree of madness

Driving from Bagni di Lucca in northern Italy to London recently, using my black labrador, Marmite, as a psychoanalyst (he is good—sparing with interpretation but a deeply thoughtful listener), I had two audiobooks on the go. In the first, Alice Hoffman’s Illumination Night, published in 1987, the main character Vonny becomes agoraphobic as her estranged father refuses to contribute to her son’s medical bills and her husband begins an affair with a teenager. Her agoraphobia, which she tries to hide by lying, is treated with long-distance therapy and she starts to make small journeys out, building up to longer drives and then ultimate freedom and plot-driven catastrophe.

In the second, Proust’s Swann’s Way, published in 1913, I was introduced to Aunt Léonie, a bedridden lady who “always talked rather softly because she thought there was something broken and floating in her head that she would have displaced by speaking too loudly.” But she also talks constantly “because she believed it was beneficial to her throat.” Though there clearly is something broken in her head, the family accept her as she is, pandering to her whims until she eventually dies.

Marmite quite rightly set me thinking about the tyranny of mental health and how we seem to regard only perfect wellness as acceptable nowadays. Léonie is humoured and left to be, whereas Vonny is seen as ill and encouraged to correct her behaviour. In many ways there was perhaps a greater acceptance of mental illness in the past—people suddenly becoming more fervently religious (something that would ring alarm bells now), roaming holy fools, ladies with “bad nerves” and so on. Obviously, palatable treatment wasn’t available (Freud, writing at the same time as she was being depicted, was too late for Léonie) so there wasn’t much choice but to accept a certain degree of madness. Nonetheless, it’s striking how quickly we now pathologise.

I have a patient with a horror of being stigmatised as mentally ill and she uses language she got from her mother to describe people (always women)—“a crazy lady,” someone whose “nerves are at her,” or someone “having a nervous breakdown.” Really this was a way of pouring scorn on anyone unable to cope with the gruelling life of post-war rural Ireland. But there was no question of these women being helped or cured, at least not until the point at which they were carted off to an institution and lobotomised.

If Léonie had been listened to, understood and interpreted, might she have got up and gone about her life again? And would that necessarily have been any better? Some anti-depressants and six sessions of therapy? Ten years of analysis? (I do feel that would have done it, but I’m biased.)

Marmite thinks there is now an enormous pressure on us to be well all of the time and that, although there is less stigma than there was about being “a crazy lady,” we stigmatise ourselves anyway with the slowness of our recoveries, feeling (and all patients say this) that “everybody else” is coping better than we do as we strive desperately to be constantly serene and jolly, to sleep well, to eat moderately, to exercise regularly, to have a perfect relationship and a nourishing social life. When, really, sometimes we just want to lie in bed for a few weeks or years eating madeleines. Don’t we, Marms?