What made Albert run
- 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.
So how do you get from normal escapist desire to mad travelling? What is the difference between these two, almost identical impulses? How did you become mentally ill? Besides, are you really ill? Ian Hacking has written a wonderful philosophical fable about these and several other equally fascinating questions. Its moral is simple, if somewhat untimely: what we call ‘mental illness’ is not a permanent, intangible reality. For it to develop, it needs a hospitable environment, what Hacking compares to an ecological niche. Without a facilitating environment, mental illness languishes, wastes away, disappears, or emigrates somewhere more propitious. You who dream of dropping everything, for example, there is almost no chance of your becoming a pathological fugueur. Our modern psychiatric bibles may still make room for the diagnosis of ‘dissociative fugue’, but there is no longer, in late 20th-century Europe, any ground on which that illness could truly thrive. A century ago it was different. Hacking is more precise (or peremptory): fugue, he claims, became an illness in 1887 with the publication of Philippe Tissié’s Les Aliénés Voyageurs, and it began to wane after the 1909 congress of alienists and neurologists in Nantes.
Hacking even gives us the name of the first pathological fugueur: Jean-Albert Dadas, an employee in a gas equipment company in the Bordeaux region. Tissié spotted him in 1886 at the Hôpital Saint-André in Bordeaux:
He had just come from a long journey on foot and was exhausted, but that was not the cause of his tears. He wept because he could not prevent himself from departing on a trip when the need took him; he deserted family, work and daily life to walk as fast as he could, straight ahead, sometimes doing 70 kilometres a day on foot, until in the end he would be arrested for vagrancy and thrown in prison.
This strange compulsion had seized him for the first time when he was 12. He had suddenly disappeared from the gas factory where he was an apprentice, and when his brother found him in a nearby town, he had seemed to awaken from a dream, astonished to find himself there. As a rule, his attacks were preceded by migraines, insomnia and sessions of intense masturbation. Dadas would then take to the road and walk, walk, till he found himself in some place that he had heard about: Paris, Marseille, Algiers, Frankfurt, Vienna, Moscow, Constantinople (Hacking provides us with a map of his impressive peregrinations across Europe). Dadas never remembered much, but Tissié quickly realised – this was 1886, the golden age of hypnotism – that you only needed to put him under hypnosis to have him recollect the sometimes picaresque details of his travels. Tissié also had photographs taken of Dadas, in which we see him in his different states: normal (perky, smiling at us); at the end of an attack (groggy, stupid); under hypnosis (asleep, eyes closed).
Vol. 21 No. 12 · 10 June 1999
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.
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.
University of Helsinki
Vol. 21 No. 13 · 1 July 1999
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.
University of Washington,
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.