To the Editors:

I am not so sure that hysterical fugues are now so uncommon in England at least as Rosemary Dinnage assumes in her review of Ian Hacking’s Mad Travelers [NYR, January 20]. Those of us working in psychiatry in close proximity to mainline railway stations not infrequently come across patients referred to us by the British police who are unable to give a clear account of their origin or destination, or indeed their personal identity. In many cases they are later to be found escaping from severe conflictual circumstances.

Two other points. I think it is now generally accepted (at least since Thomas Caramagno’s The Flight of the Mind, 1992) that Virginia Woolf experienced a manic depressive illness, not schizophrenia or hysteria. And on the medical “reality” of an illness: Does this presume its occurrence in the absence of social or medical context which might anticipate and shape it? And this, at least for psychopathology, is practically impossible. Mental illness—anorexia nervosa, post-traumatic syndrome, hysteria, fugues, depression, multiple personality disorder, domestic sieges, attempted suicide—all are shaped by their social context and shared meanings.

Roland Littlewood
Professor of Anthropology and Psychiatry
University College Centre for Medical Anthropology
University College London
London, England

Rosemary Dinnage replies:

Professor Littlewood’s addition to the history of fugueurs recounted by Professor Hacking is very interesting. Could some research be done on the backgrounds of the patients he describes?
As for Virginia Woolf’s illnesses, I am still not quite convinced that they fit into any current category. Perhaps that is the way with geniuses.

This Issue

April 13, 2000