Institutionalizing Gender

Madness, the Family, and Psychiatric Power in Nineteenth-Century France

Jessie Hewitt

• Publisher: Cornell University Press
• Year: 2020
• Print ISBN:
  9781501753312
• eBook ISBN:
  9781501753329
• Topic: History
• Subtopic: French History
• Index: History

Institutionalizing Gender analyzes the relationship between class, gender, and psychiatry in France from 1789 to 1900, an era noteworthy for the creation of the psychiatric profession, the development of a national asylum system, and the spread of bourgeois gender values.

Asylum doctors in nineteenth-century France promoted the notion that manliness was synonymous with rationality, using this "fact" to pathologize non-normative behaviors and confine people who did not embody mainstream gender expectations to asylums. And yet, this gendering of rationality also had the power to upset prevailing dynamics between men and women. Jessie Hewitt argues that the ways that doctors used dominant gender values to find "cures" for madness inadvertently undermined both medical and masculine power—in large part because the performance of gender, as a pathway to health, had to be taught; it was not inherent. Institutionalizing Gender examines a series of controversies and clinical contexts where doctors' ideas about gender and class simultaneously legitimated authority and revealed unexpected opportunities for resistance.

Thanks to generous funding from the Andrew W. Mellon Foundation, through The Sustainable History Monograph Pilot, the ebook editions of this book are available as Open Access volumes from Cornell Open (cornellpress.cornell.edu/cornell-open) and other repositories.

Chapter 1

Gender and the Founding “Fathers” of French Psychiatry

THE FIRST FRENCH ASYLUM DOCTORS aimed to cure patients of mental alienation and professionalize their medical subspecialty at a time when change represented the only constant, working against a backdrop of political turmoil, fluctuating class norms, and the rapid expansion of the centralized nation-state. These alienists, like their patients, experienced the early decades of the nineteenth century as if it were a new world—one in which doctors themselves helped define French society’s core values while attempting to impose order amid chaos. In the process, they formulated theories of the mind that intertwined with and gave force to emergent class-based standards regarding gender and family life.

Psychiatric assumptions about healthy families often served to reinforce bourgeois gender values by treating them as normative. Like postrevolutionary legislators, doctors believed the relationship between the individual and the state was mediated through the family and that the home ideally served as a bedrock against the frightening changes afflicting French society as a whole.1 The familialist thrust of French law and medicine held strong throughout the nineteenth century despite considerable differences between various governments (which included three republics, two empires, and several monarchies). Indeed, the dramatic political shifts that occurred from 1789 to 1871 help explain why the source of social stability would have to come from outside the realm of politics proper. The (re)creation of seemingly happy families—economically productive, loving, and secure—had the power to stabilize the individual as well as the nation. Asylum doctors considered the professionally successful married bourgeois the rational man par excellence. His happily domesticated wife represented the ideal woman, and bonds of genuine affection supposedly linked husband to wife and parents to children.

It is tempting to interpret early alienists’ efforts to enforce these values among their patients as attempts to discipline the popular classes and reinforce restrictive norms among their own. Yet, psychiatric understandings of the home—and the gender- and class-based social expectations it came to symbolize—were decidedly ambivalent. The most significant stresses during the nineteenth century, particularly for bourgeois and middle-class people such as asylum doctors, revolved around family life. Early alienists therefore suggested mental patients had the greatest chance of regaining sanity when they were far from their relatives. They likewise never tired of pointing out that the sources of mental alienation often resided in the “breast of the family.”2 Asylum doctors nevertheless argued a patient’s resumption of his or her familial role constituted the end goal of all treatment measures and even proof of cure. In other words, doctors recognized that social pressures related to home life often contributed to mental collapse, but they also implied a rational person would not appear to struggle with these challenges at all. In the meantime they traversed this unsettled gender landscape and began to construct their own identities as professional men.

This chapter explores the early history of French psychiatry and serves as an introduction to themes that will be picked up in later chapters. Each section represents a stage of the patient experience, from the onset of mental illness, to the patient’s arrival in the asylum, to the actual enactment of the moral treatment. The first decades of the nineteenth century established doctors’ hopes for the asylum system and their own place within it, and early alienists clearly linked the incipient specialty to the perpetuation of family and gender norms associated with the middle classes. Nonetheless, their theories and actions presaged irresolvable contradictions between the practice of asylum psychiatry and the maintenance of bourgeois class distinction.

Inventing the Patient

The insane became human sometime in the late eighteenth century—that is, at least, according to their self-appointed caregivers within the nascent psychiatric profession. Whereas those considered mad had once been enchained like “ferocious beasts” and treated with “violence and blind brutality,” Philippe Pinel and his disciples sought to approach asylum inmates with firmness and kindness.3 This alteration in perspective represented a central element of the moral treatment, a method of care first theorized by Pinel during the revolutionary era that asylum doctors continued to refine throughout the first several decades of the 1800s.

Although those considered mad had long lived within institutions, their incarceration did not serve a medical function until the eighteenth century. Relatively few prerevolutionary practitioners believed in the curability of mental illness, and the absolutist state had little interest in reintegrating mad people into society. Pinel, like his predecessors, believed those who behaved irrationally should be separated from their communities, especially their families. Yet he also advocated the removal of physical restraints in all but the most dangerous situations and insisted that insanity could be overcome by regimenting and supervising patients’ lives within asylums. In time, through a series of strategically planned interactions between doctor and patient, he expected the symptoms of madness to dissipate. The moral treatment was an individualized but routinized method of care intended to bring patients back into the community of citizens by redirecting their emotions in a normative fashion. Doctors left little to chance within their institutions, seeking instead to purposefully cultivate an atmosphere that would disorient their patients’ senses and lead them toward the path of recovery.

The first alienists believed everyone possessed a sense of reason, even those experiencing symptoms of insanity. The flip side to this professed faith in human rationality was their assumption that all people—men and women of all social backgrounds—were liable to bouts of madness under the right circumstances. Pinel suggested as much in his writings on the Revolution. He pinpointed situations that triggered extreme emotional response when discussing the causes of mental alienation among the male patients of Bicêtre during that time, including various reactions to the Terror; the reversal of fortunes; and domestic distress.4 These particular inspirations for the onset of mental illness were eminently relatable to Pinel’s readers, who had themselves witnessed and experienced the same turmoil as had the asylum’s patients. Far from labeling the insane as outside the bounds of the community, Pinel implied that those driven to the brink by the vicissitudes of political and social change were perhaps all too human, rather than the supposedly incomprehensible animals of the Old Regime.

Even during less dramatic historical interludes, psychiatry’s founders emphasized the distortion and exaggeration of universal emotional states when discussing the onset of mental illness. Pinel and his influential student Jean-Étienne-Dominique Esquirol both cited unchecked emotions as especially relevant sources of insanity, Pinel going so far as to ask how any doctor could remain ignorant of the “the most lively human passions” when “they are the most frequent causes of alienation.”5 Esquirol wrote his doctoral thesis, “Des passions considérée comme causes, symptômes, et moyens curatifs de l’alienation mentale,” on the passions, using a combination of Pinel’s case notes and his own as principal sources of evidence. He focused on how particular emotions—from tenderness and the desire for love to hate, fear, and anger—might wreak havoc on the minds of the mad. Both Pinel and Esquirol acknowledged that physical states such as lesions on the brain could cause psychological turmoil, but they consistently foregrounded the emotional dimensions of insanity in discussions of diagnosis and treatment. Madness represented a distortion of everyday “passions,” an extreme and unhealthy manifestation of the feelings experienced by all people. As such, both doctors began their attempts at cure with the belief that everyone had access to the same emotional register, arguing that if the passions constituted symptoms of mental illness, then they could inspire cure when properly manipulated. Far from merely replacing passion with reason, the founders of French psychiatry considered emotion the key feature of the human condition, connecting those diagnosed as insane to the rest of society.

Although distorted passions represented a seemingly universal source of insanity, doctors argued that emotional life was itself historically and socially determined. For Esquirol, primal emotional responses concerning self-preservation and reproduction—notably love, anger, terror, and vengeance—could easily be taken to excess. But he additionally linked mental illness to the advance of civilization and the multiplication of wants that defined modern life, explaining that needs engender desires and that desires “represent the most fertile source of the moral and physical disorders that afflict man.”6 No less treacherous for their comparative lack of urgency, new needs “attached themselves to the first,” thereby increasing the possibilities for the excitation of the passions. The feelings furthest removed from the instincts concerned those “born of our social ties,” such as ambition, greed, glory, celebrity, and honor. Like baser passions related to reproduction or survival, these so-called secondary needs related to the individual’s relationship to his or her family, whose reputation hinged on that of each individual member. Opportunities for the aggravation of such passions were especially numerous in a nominally meritocratic society such as that of postrevolutionary France, where class identities were in the process of replacing corporate ones and where one might move down the social hierarchy as readily as one might climb up. In elucidating this historically informed conception of the passions, Esquirol gave voice to a tendency already present in Pinel’s writings: emotion was universal, but its expression and its potential for unhealthy distortion was intimately tied to an individual’s social and familial role. This meant that a patient’s class and gender background inevitably influenced their diagnosis and treatment.

Psychiatric conceptions of the passions nonetheless resided at the nexus of nature and culture, where physical inspirations for insanity worked in concert with situational ones. Asylum doctors most obviously perpetuated notions of gender...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• CONTENTS
• Acknowledgments
• Chapter 1 Gender and the Founding “Fathers” of French Psychiatry
• Chapter 2 Medical Controversy and Honor among (Mad)Men
• Chapter 3 Domesticating Madness in the Family Asylum
• Chapter 4 Scandalous Asylum Commitments and Patriarchal Power
• Chapter 5 Rehabilitating a Profession under Siege
• Chapter 6 Reforming the Asylum and Reimagining the Family
• Conclusion The “Mad” Woman in a Man’s World
• Notes
• Bibliography