As the title declares, this is a book about reality. Or, more accurately, “reality.” Author of an impressive study of multiple personality (Rewriting the Soul, 1995), Professor Hacking here narrows down his interest in the extraordinary changeableness of mental symptoms to one circumscribed instance: a psychiatric epidemic of “hysterical fugues”—cases of people who suddenly left home, suffered from amnesia, and took on a new identity, at least for a while. Diagnoses of these cases began to be reported around 1886 and continued, says Hacking, for twenty-two years—then more or less disappeared.
Hysteria, of course, in the sense of a trancelike state that translated mental obsession into physical language, had been observed since the days of Hippocrates, and identified over time with diabolic possession, religious ecstasy, epilepsy, displaced womb, and any number of simulated illnesses. Its essence was that the patient dissociated feeling from conscious awareness—sent it on stage, so to speak, to act out its story. In the late nineteenth century, particularly under the aegis of the celebrated Parisian neurologist Charcot, it took weird and wonderful forms, which he tended to associate with epilepsy. At the same time, among the ordinary population, fainting and paroxysms and “vapors” were in fashion, mainly among women. These were in themselves a kind of fugue or flight; but as used by the psychiatrists cited by Hacking, fugue meant a literal flight out onto the road.
Hysterical fugues may not be everyone’s immediate first choice of subject, but Hacking tells an almost unputdownable story. Not only does he write with rare sympathy and elegance, he draws on his background in philosophy to make this byway from the history of medicine full of resonance. Were these bizarre mental illnesses, now apparently extinct, “real” ones? Are they in fact extinct, or just changed in shape? Within any one personality, can anything be discarded as unreal? What are the roles of awareness and memory in dividing up a personality? What was the popular effect of new knowledge of unconscious layers of personality? Did these discoveries influence patients’ symptoms—or vice versa? At the turn of the last century there was indeed a veritable rewriting of the soul going on, and it hardly seems finished yet. We may well feel nostalgia—a nostalgie de l’âme?—for the time when the soul was a single and sacred thing.
Albert Dadas, a semiliterate gas fitter of Bordeaux, probably concerned himself very little with the soul, though there was certainly some deep malaise within his own. Hacking has retrieved Albert’s case from a book brought out by Philippe Tissié, a Bordeaux psychiatrist, in 1887: Les Aliénés voyageurs. Mad Travelers‘ core is four lectures on Tissié’s case; these are supported by extensive notes and appendices. Hacking argues persuasively that dissociated wandering like Albert’s became a mental illness for a time, was found all over the place, and vanished when the intellectual climate became unsympathetic.
Albert was born in 1860 into an impoverished artisan family in Bordeaux. By the turn of the century he had become celebrated for his extraordinary, compulsive treks from country to country, from which he would “awake” into his normal state of mind, not knowing how he had got to the German frontier, or Constantinople, or Moscow. He would have heard the name of a foreign place, become anxious and restless, and set out. When he came to himself far from home, he would find his papers missing, get sent to jail or hospital, or scrabble for a living, and after great hardships find his way back to Bordeaux.
He became a pet project of Tissié’s, himself an unconventional young doctor, while in a Bordeaux hospital. As was the fashion of the time, Tissié hypnotized him and was able to hear accounts of his travels, which in general could be confirmed as genuine. These are appended to the main part of the book, and make rather disappointing reading: yes, he went there, and there, and then he lost his money, then he found some work, then he lost it, then the authorities sent him home, and so on. Albert was no self-examiner: “Yet another escapade. What a calamity,” is the most vivacious of his recorded remarks. His divided life certainly tortured him (and tortured his wife, for he did find time to marry), but we hardly feel we come to know him, to understand what he was traveling from, or toward.
Hacking’s use of the case is more absorbing than these bare accounts, his argument being that here was a small epidemic that arose, and fell. It raises all kinds of questions about medical rivalries and fashions in diagnosis. What fascinates Hacking is the transitory nature of psychiatric outbreaks. Why tell Albert’s story now, he asks?
Because we are besieged by mental illnesses, more neurotic than psychotic, and we wonder which of them are affectations, cultural artifacts, clinician-enhanced, or copycat syndromes, and which ones are, as we briefly and obscurely put it, real. We are profoundly confused about an entire group of mental disorders, feeling that their symptoms are both nurtured and natural, both moral and neurological.
And he cites anorexia, hyperactivity, premenstrual syndrome, antisocial personality disorder, subclinical autism, and of course multiple personality disorder; with all of these, as he puts it, “the reality question rears its tiresome head.” (Incidentally, Albert fell out of a tree and hit his head when he was eight years old, and Hacking admits that this may have been a real factor in his mental illness.) But it can hardly have been present in all the cases of hysterical fugue cited at the time.
There were no women mad travelers; women simply did not take to the roads alone. There had of course always been wandering men—eccentrics, tramps out on the road—but these were not people who split into a separate personality once the mad traveling fit took them, with amnesia for all else. So these voyageurs aliénés, Hacking says, were a new breed. He cites cases written up around the turn of the century and the various names invented for the syndrome—automatisme ambulatoire, dromomanie, fugue psychasthénique. In the United States, however, the diagnosis never caught on.
In France, controversy about mad traveling focused on a struggle between Tissié in Bordeaux and Charcot in Paris. Charcot produced a traveler of his own, a thirty-seven-year-old delivery man whose fugues were small stuff compared to Albert’s. But the great man’s influence was waning. At an extraordinary Paris congress in 1889 (the young Freud was there, and William James; from France, Binet, Bernheim, Dessoir, et al.; Myers and Sidgwick from the English Society for Psychical Research; a party was held at the Eiffel Tower that one would have dearly liked to attend) William James declared that Charcotian doctrines were becoming a thing of the past.
Hacking considers that the traveling outbreak lasted just twenty-two years, and cites another congress, in 1909, as the end of it. Fugue was much discussed there among the neurologists and alienists, but it was fugue with dementia praecox, with melancholia, with epilepsy—mad traveling was becoming just one aspect of differently diagnosed mental illnesses. The cases discussed were not confined to those with amnesia such as Albert’s. Hysteria itself as an entity was fading away, Charcot having died in 1893.
Of course flight, movement, escape, have always been associated with mental anguish. In dementia, old people run out looking for they know not what. In pain it is hard to stay still. Compulsive traveling in people more or less sane is common enough. During my 1930s childhood there was an accepted category of travelers—tramps—who trod an established route around the country between doss-houses. They were said then to be shell-shocked survivors of the trenches; Orwell describes tramping with them in Down and Out in Paris and London. Before escape through drugs was available, the fantasy of disaffected teenage boys was running away to sea or to join the circus; some even tried it out. Nowadays the language of travel advertising—mad traveling domesticated—urges us to “escape” to Spain, make a “break” for Venice. (Readers who saw the film of The English Patient may remember the perfect image of mythical flight, when the heroine, still unmarked in death, is rescued from the desert and flown off in a tiny plane, draperies streaming behind her.)
Dissociation too has not entirely vanished since the heyday of hysteria, though it changes form and now is called being “in denial.” What was special about Tissié’s Albert and patients like him was the complete split between the traveling self and the gas fitter: dissociation set in from the time Albert hit the road until he came to, poor man, in some foreign place, presumably exclaiming: “Yet another escapade. What a calamity!” (Since he was able to guide himself about and find food and shelter, it is not quite clear, during his weeks away, who and where he felt himself to be.) The mad travelers were surely absconding from true mental distress, and today might have taken their “trip” on drugs, illegal or prescribed.
An episode from Tissié’s notes perhaps shows Albert as his most true and suffering self. He shivers, and sits down by the roadside.
I saw [he said], the leaves of the trees fading, all nature invaded by a fog; the road was desolate. I had no strength, I was in pain, and I began to cry. I thought of my poor mother, telling myself that if she had lived I would have gone to the fair. I told myself that the trip Ihad undertaken was the cause of my misery…. A good woman seeing my tears and my distress invited me into her house in order to comfort me. I refused. She brought me a glass of sweetened water. I don’t know if I thanked her. After drinking, Iwiped my face and left, without knowing where I was going or what was the point of my trip. I was very unhappy. When, a kilometer later, my sadness suddenly disappeared, and I was once again contented, I began to sing….
As long as he keeps moving, he does not have to see how desolate his road is.
Hacking unravels with great care the way an “illness” reigns in the literature for a period and then, in a phrase he borrows from a contemporary, “vanishes into a hundred places in the medical textbooks.” Perhaps he tweaks the data a little to make a rounded story; one would have to know the psychiatric publications of the period inside out to make such a suggestion. The overlap between hysteria and multiple personality, between the arguments of one psychiatrist and another, does blur the picture. The gist, at any rate, is clear enough. Albert and the other fugueurs, he writes, when the difficulties of their lives made them crack, found “release in a mental illness which relieves them of responsibility, is cultured by medicine, and is medicalized in the culture of the day.” As he says, “Aimless wandering driven by irresistible impulses seems, when you come to think of it, such a natural way to be insane.”