Vol. 21 No. 11 · 27 May 1999
pages 9-10 | 2829 words
What made Albert run
Mikkel Borch-Jacobsen
- Mad Travellers: Reflections on the Reality of Transient Mental Illnesses by Ian Hacking
Free Association, 239 pp, £15.95, April 1999, ISBN 1 85343 455 8
You wake up one morning, the whole world is grey, you have had enough of your cold, colourless life. You want to drop everything, escape, far away, where life is real. Who has not had this dream from time to time? Nothing could be more normal. The desire to escape, to travel, is deeply rooted in everyone, from the young runaway to the tourist, from the beatnik to the Sunday hiker. But suppose now that this desire to flee becomes an obsession, a truly irresistible compulsion. Suppose further that it all happens in a state of absence and you cannot remember any of it: you arrive somewhere, dazed, without the slightest idea of what happened in the interval. Obviously, you have become a pathological runaway, a mad traveller, fit for the asylum and for therapy.
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Letters
Vol. 21 No. 12 · 10 June 1999
From George Hornby
In his review of Ian Hacking's Mad Travellers (LRB, 27 May), Mikkel Borch-Jacobsen wonders with Hacking whether such transient illnesses need a (fashionable) 'ecological niche' in order to exist. To be bracketed, named and collated perhaps they do, but you can become a fugueur when no such niche is apparent. George Orwell describes just such a victim in Dorothy, the submissive spinster daughter in his novel A Clergyman's Daughter (1935). Though Orwell does not explain the nature of Dorothy's breakdown, Borch-Jacobsen's supposition 'that it all happens in a state of absence' – 'you arrive somewhere, dazed, without the slightest idea of what happened in the interval' – perfectly describes her arrival on the streets of London from her East Anglian parish home.
The label may vary from one era to another but the illnesses remain.
George Hornby
Bournemouth
From J.P. Roos
The logic of Ian Hacking and Mikkel Borch-Jacobsen is very simple: science does not advance, it only changes. I disagree absolutely. Take hysteria: the cases treated by Charcot or early Freud were in many cases genuine illnesses, misdiagnosed as hysteria. They 'disappeared' with the advance of brain research, not because of a new niche. For Borch-Jacobsen, it makes no sense to ask whether an illness is real or not: he agrees with Hacking that all illnesses are the result of a co-operation between the patient and the clinician. The only question to be posed is whether an illness propagates or not!Let me just recommend that Borch-Jacobsen and Hacking read (and reread) Terry Eagleton's excellent review of Gayatri Spivak's Critique of Post-Colonial Reason, which neatly makes mincemeat of these kinds of idiotic academic game. It is a very important distinction whether an illness is real or not.
J.P. Roos
University of Helsinki
Vol. 21 No. 13 · 1 July 1999
From Mikkel Borch-Jacobsen
If J.P. Roos wants to argue (Letters, 10 June) that late 19th-century hysteria disappeared because brain research allowed a better understanding of the 'genuine illnesses' behind it, I wish him well. I would be very interested in knowing to what brain disease we should attribute the classic symptoms of Charcot's grande hystérie – the four standard 'phases' of the hystero-epileptic attack (clownisme, attitudes passionnelles etc); the 'ovarian tenderness'; the hemianaesthesias that migrate from one side of the body to the other in response to magnets; the hysterogenic points which Charcot would press to trigger or stop an attack; the sudden catalepsies provoked by the ringing of a gong; and the rest. Retrospective diagnosis is a tricky business, and just because many symptoms of hysteria can be individually correlated with specific lesions of the brain, it does not follow that the cases treated by Charcot or by Breuer and Freud can be reliably traced back to distinct neurological diseases. Whenever such attempts have been made, they have yielded inconclusive and contradictory results. How does J.P. Roos reconcile, for example, E.M. Thornton's diagnosis of Anna O's tuberculous meningitis, A. Orr-Andrawes's diagnosis of temporal lobe epilepsy and L. Hurst's diagnosis of sarcoid with lesions of the peripheral nerves?
As for the disappearance of hysteria during the first decade of the 20th century, it was due to the decline of hypnosis and, as Mark Micale has convincingly argued, to an influx of new diagnoses. Brain research played absolutely no role in that development: the indispensable diagnostic procedure for detecting most of the 'genuine illnesses' alluded to by J.P. Roos, the electroencephalogram, was not even available until much later.
Mikkel Borch-Jacobsen
University of Washington,<br />Seattle
From Linda Montague
I have obviously got stuck in pre-1909 psychiatry, as I have seen several patients with dissociative fugue states, although none of them have got as far as Albert – the last one turned up in Bassetlaw.
Linda Montague
Manchester
