The history of women and the mind doctors is not merely the history of women in psychiatry; it is the history of psychiatry itself. That fact is made clear in this informative and sweeping account of mind doctors and their patients in Europe and America over the last two centuries. Drawing on the stories of real women's experiences at the hands of psychiatrists, and depictions of mad women in novels and writings of the times, Appignanesi offers a lively account of psychiatric diagnosis, theory, and therapy with a narrative flow that pulls the reader seductively through 500-plus pages of history. As an accomplished novelist Appignanesi excels at storytelling, and this would be reason enough to recommend the book; but in placing women's stories within the social and political contexts of their times she also offers an insightful cultural history of psychiatry as it grew and changed to reflect the social and political concerns and fashions of time and place. For example, she characterizes Esquirol's invention of monomania as the first "culturally engendered diagnostic fashion" (p. 64) and explains a subtype, "ambitious monomania," embodied in the female revolutionary Theroigne de Mericourt, as a direct response to the social upheaval of the French Revolution.
Appignanesi's careful delineation of conflicting views of women's madness in different cultures, primarily France, Britain, Germany, and America, illustrates how contradictory and piecemeal the growth of psychiatry has been, rather than the monolithic discipline that we think of today. Even while central themes, such as the theory of nerves, seemed to provide a common language among early alienists (Pinel and Esquirol in France, Maudsley in Britain, Krafft-Ebing in Germany, Weir Mitchell in America), they presented conflicting accounts of what constitutes madness and what causes it. In particular, the French recognition that environmental deprivations and stresses accounted for a large part of women's mental distress contrasted with the British, decidedly misogynistic, view of women's nervous temperament and weak reproductive system rendering them especially prone to degeneration into madness. Thus, even while some alienists acknowledged the many environmental influences on madness, many retained a strong belief in the biological basis of women's madness rooted in pregnancy, childbirth, and menstruation. This discussion is set in the context of women's battle for emancipation in Europe and America. The "new woman" is always a nervous woman. As political and social pressure for women's suffrage increased, the reaction against the new woman from psychiatry grew stronger. It is no coincidence that the most misogynistic views of women presented by the new discipline of psychiatry appeared at the same time that the pressure for women's emancipation in the late nineteenth century was at its peak, as the chorus of women's voices was joined by prominent men such as John Stuart Mill. These psychiatric views of women as being particularly susceptible to nervous degeneration due to the weakness of their reproductive systems reflected the Victorian ideal of female frailty and warned of the dangers of education and exertion to the delicate nervous system of women. Comparing the Victorian to the modern era, Appignanesi asserts that not much has changed today as "'expert' voices invoke old prejudices . . . . They induce conflicts in working women by bemoaning the suffering child or the less fertile womb, all the while warning of stress, emotional depletion or worse" (p. 111).
Appignanesi believes that we have not come a long way, Baby, and offers many other insightful parallels between early alienism and modern day psychiatry. For example, commenting