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.”
But then medical fashion moved on, and another round of the diagnosis game was played.* Vagabondage and degeneracy were entering the vocabulary; the gentle care of doctors like Tissié might be replaced by jail. Drunkards and conscripts on the run were chased up; wandering came to seem an antisocial act rather than a mental illness. On the diagnostic side, dementia praecox, hallucination, de-lirium, dementia, claustrophobia all crowded on stage. French psychiatry was ceding to German, which had not stressed fugue. In the United States it had made no headway at all; multiple personality, most notably described in The Dissociation of a Personality (1906), by Morton Prince of Boston, was the preferred interpretation. And in a continent the size of North America, taking to the road was anyway a way of life. (Could the road movie be a glimpse of insane traveling? Or the figure of Charlie Chaplin, in the old silent films, disappearing down an endless road?)
Hacking does not claim that wandering accompanied by amnesia never happened before or after the Albert episode. Cases were still being described through this century, fostered perhaps, he thinks, by the rigors of compulsory conscription in Europe. Epileptic fits were known to cause confused wandering. In war, of course, there were fugues both genuine and faked. To World War I doctors, “shell shock” seemed a more scientific name than anything associated with hysteria. Pat Barker’s recent Regeneration trilogy graphically describes the psychological results of trench warfare and the treatments administered by brutal army doctors. “Post-traumatic stress disorder” is a pallid offspring of shell shock.
The mini-epidemic framework dear to Hacking rests on his theory of “ecological niches” in which a diagnosis can thrive. The temporary niche for hysterical fugue, he says, was fourfold. The taxonomy was right (the diagnosis fit psychiatric assumptions); culturally, it hovered between “virtuous” tourism and “vicious” vagabondage; it was observable (wanderers had to carry papers and show them); and it provided release for distressed, frustrated men. He sees mad traveling as a kind of sad reflection of other kinds of traveling that were becoming fashionable: on the one hand, writers and artists—Rimbaud, Gauguin—were going far afield; on the other, the respectable hand, organized tourism was expanding under the direction of Thomas Cook. Even the dust jacket of Mad Travelers, showing Caillebotte’s portrait of Monet trudging along a road, is not without significance. Did not some of Monet’s most revolutionary paintings record the steam and bustle of the Gare Saint-Lazare, where he sat surrounded by the rue de Constantinople, de Vienne, de Moscou, de Lisbonne, de Rome? The global village was already on the horizon.
Even more striking is the relation of literature to medical history. If there was a novel featuring a fugueur Hacking does not mention it, but fiction built around personality dissociation had been appearing since the mid-century: Dostoevsky’s The Double, Du Maurier’s Trilby, The Strange Case of Dr. Jekyll and Mr. Hyde, of course, and much more. Hacking quotes from Schnitzler’s Traumnovelle of 1926, now famous as the source for Stanley Kubrick’s final film, Eyes Wide Shut. The protagonist contemplates fugue:
He recalled certain strange pathological cases which he had read in books on psychiatry, so called double-lives. A man living in normal circumstances suddenly disappeared, was not heard from, returned months or years later and didn’t remember where he had been during this time.
Albert could be said to have traveled with eyes wide shut.
Did life imitate literature, or vice versa? The reciprocal influence is indeed mysterious. When Goethe’s hero in Die Leiden des jungen Werthers ended by committing suicide, there was said to be an outbreak of young men’s suicides throughout Germany; the same thing (so I understand) happens when a pop star or film star kills himself, or even when an ordinary adolescent’s suicide is widely publicized. Yet Albert Dadas, who was barely literate, had certainly not read about personality dissociation in Poe or Dostoevsky, or perused the psychiatric journals.
Behind the whole preoccupation with the fragmented person stood hypnosis (or magnetism, or mesmerism)—“the most significant discovery ever made,” said Schopenhauer. Ever since Mesmer’s time it had been in and out of fashion, defined and redefined, attached to and then again detached from psychiatry, but all the time reinforcing the knowledge that surface behavior could be just a veneer. Tissié’s acquaintance with Albert’s travels was of course only obtained from him under hypnosis. We ignore hypnosis as a serious subject now just because it is too baffling to explain how the psychologist Pierre Janet could silently hypnotize a patient from a mile away, or James Esdaile carry out hundreds of major operations in India without anesthetic. These have been, as Hacking pointed out in his Rewriting the Soul, consigned to the category of “marvels”:
Marvels are meanings out of control. You can expel a topic from science by making it a marvel. Conversely, if you are forced to look a marvel in the face, the thing to do is to bring it into the laboratory. There it will languish and die until the laboratory itself is cast out of science. Then it will become a marvel again, but it has been somehow rendered less potent because it has been declined a laboratory niche.
This, as he rightly says, has been the fate of psychical research, which, since the days when William James, Sigmund Freud, and the founders of the Society for Psychical Research partied together on the platform of the Eiffel Tower, has lost status in step with hypnosis. Freud gave up using hypnosis in therapy. Hacking interprets this as some sort of crisis of truth—Janet achieving “marvel” cures by persuading hypnotized patients they were well, Freud abandoning hypnotic suggestion in order to make patients pursue the real truth. (Or was it just that Janet was a brilliant hypnotist and Freud a lousy one?)
Personality dissociation has not just gone away—perhaps never will. It has been chronicled everywhere, from ancient Greece to Siberia to Lady Macbeth in Dunsinane. Her sleepwalking trance was classically Freudian, a result of repressed guilt; historically, it has more often had divinatory or religious connotations. Certainly fugues and hysterical paralyses and all the curiosities of the nineteenth century are scarcely seen now, and it seems that people do not go into profound hypnotic trance so easily. If not, why not? Comparison of folk-healing techniques with Western psychotherapy, as in Sudhir Kakar’s Shamans, Mystics and Doctors (1982), suggests that it may be because the unconscious has been demystified in the West, its lying tricks exposed. But it could be argued that dissociation has made a triumphant comeback in the recent American outbreak of multiple personality disorder (MPD) cases that was the subject of Rewriting the Soul. Consider also drugs, soft and hard; discos and all-night “raves”; Transcendental Meditation, popularly approved; pop festivals; New Age-style therapies like rebirthing; hypnotic regression; “happy clappy” charismatic Christianity; psychosomatics; the placebo effect; out- of-body experiences. Hacking even suggests that people prefer highway driving to taking the train because of the trancelike state it induces—a worrying thought. And then there is the mediumship of the spiritualist séance: by no means extinct, but dismissible because it is only a marvel.
Symptom language certainly changes. The apparent huge rise in depression could be due to the corresponding decline in hysteria; people do not need to go on fugues or paralyze themselves to prove to the doctors that they are wretched. Wonderful new diagnoses arise: male film stars go into clinics to be cured of sex addiction, a kind of certificate of their irresistible attractiveness. (Women, as far as Iknow, have not pinned this label on themselves.) Cases from the past can still puzzle: take Virginia Woolf and her mother, Julia Stephen. When Virginia was thirteen, her mother, aged forty-nine, apparently went to bed, said goodbye to the children, and died. The main cause of death on the certificate was “exhaustion.” It was understandable that the child Virginia should have a kind of nervous collapse. But the collapses that Woolf went on to have in later life, which, in breezy Bloomsbury fashion, she called “going mad,” seemed hardly to be schizophrenic, or yet quite depression, or yet hysteria. Was she living on some crux between nineteenth-century and twentieth-century phraseology, which shaped her symptoms?
So, finally, to the reality question again. Hacking wraps it up (though he would probably agree that it was not wrappable) in a final chapter entitled “Five Questions, Five Answers.” The questions are the following: What made fugue possible as a medical diagnosis? What did those old fugueurs suffer from? Were doctors of the day warranted in holding hysterical fugue to be a real mental illness? Was hysterical fugue a real mental illness? Are analogous conclusions to be drawn about transient mental illnesses today?
The first question he answers with his theory of the fourfold niche for fugues. The answer to the second can be summed up as: sometimes brain damage, sometimes epilepsy; otherwise, the fugueurs simply suffered from fugues. And third, were doctors like Tissié then warranted in believing them to have a real mental illness? Emphatically yes, Hacking says, given the assumptions of the time—but he stresses that “warranted” does not mean “right.”
Question number four is what his lecture audience must, by this time, have been agog to hear answered; the answer this time is “no.” The philosopher in Hacking takes over the reality question, and he turns to the pragmatism of C.S. Pierce: “The opinion which is fated to be ultimately agreed to by all who investigate, is what we mean by the truth, and the object represented in this opinion is the real.” Since we no longer use the diagnosis, hysterical fugue is no longer a real mental illness—though it could conceivably become one again. Hacking hopes not (why? it seems a healthy, outdoor form of madness compared to most). He believes that psychiatry is in any case in a transitional stage, with new research and new drugs appearing, and psychotherapy taking new forms.
Last comes the question about present-day transient mental illnesses. Yes, he says, they are in the same position as those of the previous century. For the recent craze for multiple personality disorder there was a niche—he cites identity and gender confusion, family disintegration, trauma studies, even afternoon talk shows as relevant. MPD, he believes, was a sincere diagnosis, but it went wild.
He hopes that it too will disappear forever, and post-traumatic stress disorder as well. This latter wish could provoke argument. Is there not a case for illness that is caused by massive insult to the mind? Perhaps the reply would be that there is a result of the insult, but not an illness caused by it. Once there is a label, certainly, it will be overused. What about the indeterminate “personality disorder”? If a person were a tree that grew up crooked in a windy corner, a gardener might invent the “east wind disorder” and move it. May there even be insults to the planet that make us ill? (Pace Elaine Showalter, the Ministry of Defence in Britain has just recognized Gulf War syndrome.) I wonder whether Hacking cherishes a hope that changes in nomenclature could reduce human suffering. I am afraid Beckett was right, though: “The tears of the world are a constant quantity.”
In his introduction, Hacking remarks that though current fiction is much preoccupied with psychiatric puzzles, in our accounts of medical history we now lack “the great narrative scope of the old French case histories, even of Freud himself, to get a glimpse of how our fellow men and women break up, in a time and at a place.” Mad Travelers can compete with, sometimes outshine, the best of them.
January 20, 2000