On Asylums, Mental Illness, and Controlling Women’s Emotions

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In 2019, I was just digging into what would become my fourth historical novel. Set in 19th century Pari’s infamous Salpêtrière asylum, it follows two young women: Josephine, who arrives at the hospital stripped of memory and covered in blood, and Laure, a recovered hysteric who helps Josephine navigate the surreal world she’s now trapped in. It’s a world in which Jean-Martin Charcot, the Salpêtrière’s famous director, not only studies, photographs, and publishes on his traumatized female patients, but hypnotizes them into violent, even sexualized manifestations of their illness, often in front of hundreds of curious spectators.

It may sound like the stuff of horror novels. But like all my books to date, The Madwomen of Paris draws on real historical figures and events. Charcot was a medical titan; a brilliant clinician to whom medical students worldwide—including Sigmund Freud, Georges Gilles de la Tourette and Pierre Janet—flocked for mentorship and guidance. Over the course of his career he’d identified both Parkinson’s and ALS (still known as “Charcot’s Disease” in some countries), and been christened “the Napoleon of Neuroses” by the press. But for his final medical conquest—the one he hoped would seal his legacy—he’d set his sights on hysteria, a disorder that had puzzled clinicians for millennia, and which by the late 1800’s was infecting so many French women that one Parisian editorialist dubbed it the malady of our age.

Using asylum wards as his laboratory, Charcot plucked women he’d diagnosed with the illness, prompting a dizzyingly range of symptoms that included everything from epileptic-style attacks to stigmata. Hysterical episodes were famous for unfolding in such rapid and erratic fashion that most doctors couldn’t make sense of them. But hypnosis—a practice formerly relegated to carnival-style sideshows—allowed Charcot and his interns to slow these attacks down; to separate catatonia from contracted limb and seizure from scream-inducing hallucination. It also allowed them to trigger hysterical attacks on cue in the weekly public lectures for which Charcot was already renowned for within the medical community; lectures that—not surprisingly—became wildly popular among the general populace once they began featuring half-dressed, contorting young women. That some of these women were clearly reliving sexual trauma was a fact he pointedly ignored, dismissing one subject’s wails as “sound and fury, signifying nothing,” and paralyzing another’s tongue­ for days when her chatter annoyed him. He himself was the first to note that he had no interest in what these women had to say. His focus was what their bodies told him about their disease.

Researching this little-known chapter of medical history, I was both intrigued and deeply troubled. For all of Charcot’s insistence that hysteria was—like Parkinson’s—a neurological disorder (he spent years examining hysteric’s brain tissue for physical lesions), it was arguably something far more vital for hysterics themselves: the one expression of their trauma that their doctors—not to mention a prurient Parisian public—would listen to. It was therefore all the more ironic that while hysteria provided a vernacular by which hysterics could share their anguish, it gave doctors like Charcot a convenient excuse to dismiss that pain as a mere offshoot of a “real” physical disease—sound and fury, signifying nothing—even he displayed their torment publicly and, in the process, accrued even greater medical celebrity.

These were complex themes to unpack, and challenging material to work with narratively. But I was excited by the opportunities Madwomen offered: not just to explore this strange moment’s real-life Gothic aspects, but to give the Salpêtrière’s women back their voices, and to give them a stage of their own—one not constructed by powerful men to leverage female suffering into professional gain. I think I was also hopeful that writing their stories would affirm, for both myself and my readers, how much better things are for women today. Unfortunately, though, over the three-odd years I spent buried in 19^th century worldbuilding, the 21^st-century world kept offering evidence to the contrary.

I’d stumbled on my first photograph of a Salpêtrière hysteric—Augustine Gleizes—in 2017, just as the #MeToo movement gained momentum. The news cycle roiled with revelations about Harvey Weinstein’s serial sexual assaults, and as I worked through my early chapters, more powerful men were making headlines for similar reasons: Jeffrey Epstein. Larry Nassar. Bill Cosby. U.S. president Donald Trump. I was crafting a scene where Josephine relives a violent sexual attack on Charcot’s stage while Christine Blasey Ford was on national television, testifying that Brett Kavanaugh—Trump’s SCOTUS pick—sexually assaulted her in high school. Her accusations were mocked by Trump and dismissed as a “made-up scandal” by Republican senators, who ultimately rammed through Kavanaugh’s confirmation to the Court. There he joined Clarence Thomas, a Justice accused of sexual harassment by Anita Hill three decades earlier. It seemed chillingly fitting that as I worked through my final Madwomen revisions four years later, both men voted to overturn Roe vs. Wade, stripping women of the constitutional right to control their own bodies.

And of course, it didn’t end there, because it never does. (As Faulkner famously said, “The past isn’t dead. It’s not even past.”) Just this year Trump—who’s been accused of sexual misconduct by over two dozen women since the ‘70’s—had to answer to one of those charges in New York civil court. The jury found E. Jean Carroll’s claim that the former president assaulted in 1996 believable enough to award her five million dollars, despite Trump’s attempts to paint her as a “nut job” and “mentally sick”. It was a gratifying, if hard-won victory. But it didn’t stop CNN from handing Trump a stage from which to attack Carroll again the following day, calling her a “whack job” as hundreds of his supporters cheered, jeered and whistled.

And of course, no amount awarded in a courtroom can erase the profound damages done to the women by Trump and others like him. Like the survivors I write about in Madwomen, they’ll struggle with the repercussions of those attacks for years; with disorders like PTSD, anxiety and depression. With feelings guilt, shame and low self-esteem. With flashbacks, intrusive thoughts, and nightmares that researchers now tell us are on par with those suffered by veterans of war. It’s all the more discouraging given that women already battle mental disorders at significantly higher rates than men; though at least one study hints that that discrepancy might well be because women experience sexual violence at such disproportionally high rates (one in three worldwide, according to the World Bank). And it’s not just our mental health that’s at risk. Other recent research links sexual violence with medical conditions like high blood pressure, dementia and stroke.

All of this certainly informed my novel’s historical, fictional narrative, as did a growing recognition of just how arbitrary such designations (reality and fiction, past and present) really are. And yet it’s also made me more aware—and more appreciative—of how powerful women’s voices are today. Unlike Wittman, whose abrupt “recovery” from hysteria after Charcot’s 1893 death was arguably the most potent challenge anyone made to his theories, women today have formidable platforms through which to articulate grievances and effect change. The #MeToo movement was ample evidence of that. But it’s also reflected in the numbers: more women hold positions of political decision-making than at any other moment in history, particularly in policy areas related to gender equality, human rights, and social affairs. Women also make up more than half of the nation’s medical students, and 36.3% of the physician workforce. True, they’re still paid less than men for that work. But they bring something to it my “madwomen” never had: a willingness to really listen. Not just to female bodies, but to what female voices actually have to say.

As for me: my growing awareness of the endurance of Madwomen’s grim themes may not have lightened its plot points, or the dark history behind them. I’ll even admit that it did the opposite; that there’s real rage in some of those pages, and I saw no reason to soft-pedal it. But it also inspired me to imbue my characters with the same grit and resilience that I’ve so admired in women like Dr. Ford, Anita Hill, E. Jean Carroll, and so many others I know who’ve suffered and survived sexual assault. They are not the compliant, “hysterical” specimens the men in their worlds wanted them to be, but strong, fully self-actualized heroines; ones who not only reclaim their bodies and stories from men who seek to control them, but who forge their own rich, subversive narratives in the process.

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