MENTAL HEALTH

A popular contemporary joke says that anyone ahead of you driving slower than you want to go is an idiot and that anyone who passes you is a maniac. If someone disagrees with one's point of view, one might ask, "Are you crazy?" One might describe a chaotic classroom as like bedlam. People freely, even humorously, use the terms of mental health to define not only others but also themselves. The literary critic Shoshana Felman, in her study Writing and Madness, says, "To talk about madness is always, in fact, to deny it. However one represents madness to oneself or others [for example, a novelist to his or her readers], to represent madness is always, consciously or unconsciously, to play out the scene of the denial of one's own madness" (p. 252). Fictional representations of mentally disordered characters appear in the earliest works of American literature. The novel Wieland (1798), by the first professional belletristic writer in America, Charles Brockden Brown (1771–1810), is narrated by a confessed madwoman, Clara Wieland. Clara's brother, Theodore Wieland, thinks that God has spoken directly to him and commanded him to kill his family, but he has been tricked by a ventriloquist. His sister Clara analyzes her own feelings as she tells this tale of disturbing psychological imbalance.

A number of other classic American novels from the nineteenth century present characters with mental disorders. A mentally unhinged singing master, David Gamut, in James Fenimore Cooper's The Last of the Mohicans (1826), moves freely amid the murderous Magua and his band of Hurons because lunatics received reverential treatment. Nathaniel Hawthorne's (1804–1864) masterpiece The Scarlet Letter (1850) presents the demoniacally insane character of Roger Chillingworth, whose obsessive desire for revenge against his unfaithful wife, Hester Prynne, and her lover, the Reverend Arthur Dimmesdale, propels the novel's plot. Rather than acknowledge his situation in a stable fashion, Chillingworth—himself a physician with an understanding of medicinal herbs—displays neurotic behavior that seeks to rectify his feelings of betrayal by cunningly inflicting misery on others. The literary reputation of Hawthorne's friend and neighbor Herman Melville (1819–1991) rests with general readers largely on the basis of one novel: Moby-Dick (1851). Melville's character Captain Ahab is most often described by critics as being megalomaniacal (desiring omnipotence) or monomaniacal (pathologically obsessed with one idea) because of his single-minded purpose of using his ship and its crew to get revenge on the white whale that physically harmed him by biting off his leg; Ahab is unable to grasp the extent to which Moby-Dick caused him psychological harm.

Readers of literature typically want to see characters who resemble themselves but who also differ in some degree—better looking, wiser, more adventurous. Readers' interest also extends to characters who are psychotic, conflicted, emotionally disturbed, especially those who advance the story by means of deviously constructed schemes growing out of some form of mental derangement. In the early twenty-first century one refers to people with various mental disorders with compassion, but not so long ago in America individuals with mental illness were routinely called lunatic, maniac, mad, evil-possessed, deranged, and the like. Manifestations of odd behavior that both amuse and unsettle one have become a staple of American literature, whether in the form of minor characters such as Cooper's David Gamut or central characters in twentieth-century novels such as Frederick Exley's A Fan's Notes (1968) and Ken Kesey's One Flew over the Cuckoo's Nest (1962), both of which are principally set in psychiatric hospitals.

MENTAL HEALTH IN COLONIAL TIMES

The earliest settlers in America clustered for mutual protection and support in villages and towns along the eastern seaboard, so society was "urban" in the sense that people lived in close proximity. Aberrant behavior was readily apparent in these close-knit settlements that grew progressively into towns and cities. The citizen majority who consider themselves sane determine which individuals are not sane. Forms of insanity have always existed in American community life, and novelists and poets reflect these aberrancies in their writings. In literature, corruption, crime, or mental instability typically occur in cities, while the bucolic, scarcely populated countryside represents purity and normalcy. In colonial times, mentally handicapped people in American urban communities were kept by their families in private homes, but some towns housed the violently insane in jails with common criminals or in almshouses with the poor. As communities grew, they began developing institutions for the mentally ill as early as the middle of the eighteenth century.

The first mental hospitals arose in or near major cities—Philadelphia, Williamsburg, New York, Boston, Hartford, Lexington. The establishment of these specialized hospitals during colonial times was consistent with the egalitarian attitude that America could cure all its societal ills in its quest to improve upon the European culture from which it sought to dissociate itself. With characteristic optimism, Americans thought that if something was wrong, a solution lay in setting about to correct it. If some individuals were insane, then insane asylums would solve the problem. In 1751, when the first general hospital in the British North American colonies was founded in Philadelphia, Benjamin Franklin urged that it include facilities for the treatment of the mentally ill. In 1766 Governor Francis Fauquier of Williamsburg argued in the Virginia House of Burgesses for the establishment of a mental hospital. Norman Dain notes that Fauquier called attention to "a poor unhappy set of People who are deprived of their Senses and wander about the country, terrifying the Rest of their Fellow Creatures" (p. 7). He called the insane "miserable Objects who cannot help themselves" and called upon the colony to "endeavor to restore them to their lost Reason" (p. 7).

As state mental hospitals appeared, families often relinquished the care and treatment of the mentally ill from the home to the institution. Families were not only relieved of the burden of caring for a loved one in the home but also comforted by the developing medical specialty that treated the mentally afflicted. They did not send relatives away to be chained in a dungeon but to be cared for by trained professionals whose abilities surpassed that of family members. Communities actively sought to establish these facilities as a mark of their cultural progression and civic pride in caring for their citizenry. Nor were these hospitals simply madhouses where pandemonium reigned. Benjamin Reiss writes that the doctors at the New York State Lunatic Asylum at Utica, founded in January 1843, practiced medical intervention with their patients, but they became known for their innovative treatment of insanity as the result of a psychological or moral cause. In a nurturing environment, they closely monitored their patients and engaged them in useful and enriching activities such as reading, writing, performing plays, worshipping at chapel, and learning marketable skills.

MENTAL HEALTH AND SLAVERY

As the nation grew and as hospitals for the insane became widespread, a special problem arose. Before the Civil War, most asylums in the United States, both North and South, either refused admission to blacks or gave them inferior treatment and facilities. Indeed, common knowledge among both medical professionals and lay people held that blacks and whites were so different in every way that they could not even suffer the same forms of mental illness. Peter McCandless writes that South Carolinians admitted slaves to their state mental hospital in 1848 but not necessarily out of a sense of altruism. Politically, the admission of blacks blunted some abolitionists' criticism of the generally harsh treatment of slaves in the South.

The novelist and poet William Gilmore Simms (1806–1870), one of the most talented writers in the South and a native of Charleston, South Carolina, published his first novel, Martin Faber, a psychological study of a criminal, in 1833. He also spoke out on the issue of slavery and mental illness. Simms argued in an essay titled "The Morals of Slavery" (1838) that the slave system actually encouraged mental stability because the slaves had no concerns about the future, no worries about supporting themselves or their children, and no anxiety about being cared for in old age. Simms's views carried great weight in the South because of his influential position as editor of the prolavery Southern Quarterly Review (1849–1856), a widely circulated periodical with a strong regional slant that published stories, poems, book reviews, and essays. Others in the antebellum South dismissively thought that distinctive mental disorders occurred in blacks because of their belief in witchcraft, conjuring, spells, and potions—the deeply rooted cultural beliefs that originated in Africa and the Caribbean and were brought to America by the slaves. The African American writer Charles W. Chesnutt (1858–1932) uses conjuring as a psycho-physiological motif in his short story "The Goophered Grapevine," first published in 1887 but set in the antebellum South. The story depicts a slave whose physical appearance changes with the seasons of the year because of his belief in the power of a conjuring or spell cast on him.

A New Orleans physician, Samuel Cartwright (1793–1863), believed that slaves sometimes suffered from a peculiar form of mental illness that he termed drapetomania, the abnormality that caused slaves to run away, from drapeto, meaning "to flee," and "mania," "an obsession." Clearly, however, Cartwright had subjective motives for his peculiar example. Harriet Beecher Stowe (1811–1896), in a very different sense, employed the motif of the runaway slave in her widely influential novel Uncle Tom's Cabin, first published serially in the magazine the National Era in 1851 and 1852. Uncle Tom does not run away because his deep religious faith allows him to transcend his servitude; he will receive his freedom in heaven. But in one of the most memorable scenes in the novel, the slave Eliza Harris, holding her young son Harry, leaps from one ice floe to the other over the Ohio River in her successful escape from Kentucky to Ohio. Her husband, George, later runs away and is united with his wife and child. One of the ironies apparent to modern readers concerning an attempt to invent a medical term for the act of a slave's running away is that the institution of slavery itself represented a sort of regional insane asylum, a vast madhouse populated with slaves as unwilling inmates. To want to escape from a place of madness must surely be a form of sanity, not insanity.

QUACKERY

Because mental illness manifests itself in such a variety of individual ways, no single method of treatment or panacea drug is likely to be discovered. Certainly the modern day pharmacopoeia can bring about dramatic improvement in patients suffering from depression, schizophrenia, and other neuroses. In the early to mid-nineteenth century, psychiatry was an unknown term. Patients suffering from mental illness received treatment for their symptoms, not the underlying causes of the symptoms. If patients were violent, they were restrained. If they spouted nonsense and could not communicate, they were isolated from those who could talk sensibly. During this period in American history, some of the cures advocated by respectable physicians seem ridiculous in the early twenty-first century: shaving the patient's head and washing it with vinegar, making the patient stand under a waterfall, or pouring cold water on his or her head. The reasoning behind these practices held that if the patient is "out of his or her head," the problem must lie within the head itself; therefore, the application of physical therapies to the part of the body that is disordered must be the correct medical approach. Other cures called for a regimen of exercise, fresh air, games, special diets, bleedings, purges of the bowels, cold baths, the administration of various tonics, excursion trips to exotic locales, and the imbibing of alcohol.

One can see that the imprecise understanding of mental illness invited all sorts of quackery. Among them, as is now known, was the practice of phrenology (from the Greek phren, "the mind"; hence the word "frenzy"). Commonly misunderstood as simply feeling the bumps of one's skull, a phrenological reading was, in fact, analogous to the palpations of a modern clinician who feels and thumps not simply the exterior of a patient's body but also, and more importantly, the organs within; their sizes, shapes, and sounds can tell a skilled practitioner much about the patient's condition. Similarly, the skull and its bumps are not as crucial as the form of the enclosed brain. A trained phrenologist was believed to be able to read the bumps that reveal the shape of the brain beneath them. These shapes were said to indicate a person's behavioral qualities such as combativeness, wonder, cautiousness, ideality, and benevolence. Once diagnosed, the patients were encouraged to modify their behavior to suppress bad tendencies and endeavor to adhere to the good tendencies.

Enjoying its greatest respectability from the 1820s through the 1840s, phrenology, in its early stages, was a serious attempt at discovering the origins of human behavior. This quasi-scientific field of inquiry now belongs to the netherworld of palmistry, soothsaying, and snake-oil elixir treatments. In an era when devices such as sonograms, computed tomography imaging (CT scanning), magnetic resonance imaging, and X-rays were still yet to be imagined, a group of the most esteemed medical doctors in Philadelphia proposed testing the validity of phrenological theory by measuring and examining the brains of selected individuals who were known achievers, so the first phreno-logical society was established there in 1822. The German neurologist Johann Gaspar Spurzheim taught a course in phrenology at Harvard Medical School in 1832, increasing the discipline's following among physicians and the public in general. In 1839 George Combe, a Scottish phrenologist, delivered a series of lectures at the Philadelphia Museum. Edgar Allan Poe studied Combe's Lectures on Phrenology (1839) for assistance in writing his 1839 short story "The Fall of the House of Usher."

The second edition of Walt Whitman's Leaves of Grass was published in 1856 by Fowler and Wells, a company whose officers were, in fact, phrenologists. The brothers Orson Squire Fowler (a classmate of Henry Ward Beecher at Amherst College) and Lorenzo Niles Fowler along with Samuel R. Wells operated their phrenological cabinet in New York City following the success of their operation in Philadelphia. Lorenzo Fowler examined Whitman's cranium in July 1849, and it is possible to match, as scholars have done, all the qualities of Fowler's reading with selections from Leaves of Grass because Whitman consciously inserted phrases and imagery that would complement the reading. Although Whitman retained some references to phrenology until his masterwork's final edition in 1892, he gradually distanced himself from practitioners of the pseudoscience when they were supplanted by sincere, progressive alienists—the original term for psychiatrist.

Without completely embracing phrenology, most of the principals in the transcendentalist movement showed interest. Amos Bronson Alcott, the leader of the transcendentalists at his commune Fruitlands, gave little credence to phrenology, although he willingly sat for at least four readings in the 1830s, including one reading by Lorenzo Niles Fowler.

Initially fascinated with the promise of phrenology to decipher character, Ralph Waldo Emerson (1803–1882) later rejected phrenology. Perry Miller quotes Emerson as saying, "Phrenology laid a rough hand on the mysteries of animal and spiritual nature, dragging down every sacred secret to a street show" (p. 499). Even as he condemned its coarser aspects, Emerson credited phrenology with having "a certain truth to it; it felt connection where the professors denied it" (p. 499).

Margaret Fuller, who had a phrenological reading, was more enthusiastic than most of her transcendentalist friends, believing that any effort to understand the mind a worthwhile study; the parallels between idea and nature were central to transcendentalist thought. Theodore Parker, whose keen mind Emerson admired, credited the phrenologists with weakening old ways of thinking and inviting progress in understanding the nature of humankind. The transcendentalists' reaction to phrenology varied, and it never became integral to their movement; they viewed it as they would any scientific inquiry into the mind, and as phrenology's general appeal faded, so did their interest.

A REPRESENTATIVE WRITER

Of all American writers in the mid-nineteenth century, Edgar Allan Poe (1809–1849) is most often associated with madness or instability. A possible exception to this claim may be made for Jones Very (1813–1880), a minor poet and tutor in Greek at Harvard who insisted that his sonnets were communicated to him by the Holy Ghost. Very voluntarily committed himself to an insane asylum. Poe's legendary alcoholism and other unusual behavior such as his marriage to his thirteen-year-old cousin suggest an unstable individual. Lorenzo Niles Fowler conducted a phrenological reading of Poe (the date is not certain) and published his reading in the Illustrated Phrenological Almanac for 1851 (1851). The reading wove phrenological theory with the circumstances of Poe's life, such as his mother's career as an actress, his being orphaned at a young age, and his alienation from his foster father, to account for his personal behavior as well as his highly psychoanalytical writings.

Poe is foremost in American literature for using psychological abnormality in poetry and fiction. His poem "The Haunted Palace" (1839) symbolizes a deranged mind, and his most famous poem, "The Raven" (1845), presents a tormented narrator mourning the loss of his lover and imagining a dialogue with a fantasy bird. Among tales in which Poe uses insanity as a theme are "The Cask of Amontillado" (1846), "The Fall of the House of Usher" (1839), "The Black Cat" (1843), and "The Tell-Tale Heart" (1843). Without knowing the modern-day terminology for depression, Poe's unnamed narrator in "The Fall of the House of Usher" describes his friend Roderick Usher as "alternately vivacious and sullen" (p. 721), a clear example of bipolar disorder. As Roderick's mental state deteriorated, he "rocked from side to side with a gentle yet constant and uniform sway" (p. 729). Modern psychotherapists would view this action as part of the rapid cycling that signals the onset of a complete breakdown.

The narrator of "The Tell-Tale Heart" talks to investigating police after he has committed a senseless murder of an old man. He challenges the police: "How then am I mad? Hearken! and observe how healthily, how calmly, I can tell you the whole story" (p. 731). The narrator tells the police that "what you mistake for madness is but over-acuteness of the senses" (p. 731). The more he attempts to appear calm during the interrogation, the more excitable he becomes, especially as he thinks he hears the incessant beating of the heart of his victim lying beneath the boards of the floor. The only way the narrator can expiate himself of his intolerable guilt is to confess. The role of the police in this story is similar to that of a modern-day psychoanalyst. By allowing the narrator to tell his tale, to talk it out, the disturbed person arrives at his own cure: confession.

Because mental health—or mental illness, depending upon one's point of view—is part of the shared human experience, literature and madness have been intertwined since the earliest forms of storytelling, enriching generations of listeners and readers. In legends, folklore, mythology, and the Bible, evidence abounds that readers and writers have a continuing fascination with the abnormal and the inexplicable, a psychic belief in the supernatural, a fascination with the grotesque, and a respectful awe of the fearful aspects of the human psyche.

See also "The Fall of the House of Usher"; Leaves of Grass; Moby-Dick; Philosophy; Proslavery Writing; Psychology; "The Raven"; The Scarlet Letter; Science; Slavery

BIBLIOGRAPHY

Primary Works

Miller, Perry, ed. The Transcendentalists: An Anthology. Cambridge, Mass.: Harvard University Press, 1950.

Poe, Edgar Allan. "The Fall of the House of Usher." 1839. In The Norton Anthology of American Literature, edited by Nina Baym, shorter 5th ed. New York: Norton, 1999.

Poe, Edgar Allan. "The Tell-Tale Heart." 1843. In The Norton Anthology of American Literature, edited by Nina Baym, shorter 5th ed. New York: Norton, 1999.

Secondary Works

Dain, Norman. Disordered Minds: The First Century of Eastern State Hospital in Williamsburg, Virginia, 1766–1866. Williamsburg, Va.: Colonial Williamsburg Foundation, 1971.

Davies, John D. Phrenology: Fad and Science: A Nineteenth-Century American Crusade. New Haven, Conn.: Yale University Press, 1955.

Feder, Lillian. Madness in Literature. Princeton, N.J.: Princeton University Press, 1980.

Felman, Shoshana. Writing and Madness. Ithaca, N.Y.: Cornell University Press, 1985.

Hemenway, Robert. "Brockden Brown's Twice Told Insanity Tale." American Literature 40 (1968): 211–215.

Hungerford, Edward. "Poe and Phrenology." American Literature 2 (1930–1931): 209–231.

Hungerford, Edward. "Walt Whitman and His Chart of Bumps." American Literature 2 (1930–1931): 350–384.

McCandless, Peter. Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonel Period to the Progressive Era. Chapel Hill: University of North Carolina Press, 1996.

Myerson, Joel. "Mary Gove Nichols' Mary Lyndon: A

Forgotten Reform Novel." American Literature 58 (1986): 523–539.

Reiss, Benjamin. "Letters from Asylumia: The Opal and the Cultural Work of the Lunatic Asylum, 1851–1960." American Literary History 16 (2004): 1–28.

Reynolds, David S. Walt Whitman's America: A Cultural Biography. New York: Knopf, 1995.

Russo, James R. "'The Chimeras of the Brain': Clara's Narrative in Wieland." Early American Literature 16, no. 1 (1981): 60–88.

Scull, Andrew, ed. Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era. Philadelphia: University of Pennsylvania Press, 1981.

Stern, Madeleine B. "Poe: 'The Mental Temperament' for Phrenologists." American Literature 40 (1968–1969): 155–163.

Shepard, Odell. Pedlar's Progress: The Life of Bronson Alcott. Boston: Little, Brown, 1937.

Trautmann, Joanne, ed. Healing Arts in Dialogue: Medicine and Literature. Carbondale: Southern Illinois University Press, 1981.

Philip W. Leon