Literature and Medicine; narratives of mental illness.

illness as demon possession continued to appear in the 18th and early 19th centuries, even as cultural beliefs about the causes of madness were moving away from a religious model to a secular one that considered mental illness as a defect or disorder of the faculty of reason. This secular way of understanding madness led to the development of both private and public asylums for the confinement of the mentally ill. The goal of the earliest asylums was simply to provide custodial care and to separate the mentally ill from the rest of society. As new philosophies of humane care emerged in Europe at the end of the 18th century, conditions improved in some institutions, and by the late 19th century there was cautious optimism about potentially effective treatments. Even so, the harsh conditions, cruelty, and abuses that persisted in many institutions evoked narratives of protest from patients who recovered well enough to be released and to write about their asylum experiences. These accounts began to appear in the 18th century, and their incidence and urgency increased as the numbers of asylums and their inmates grew during the 19th and early 20th centuries. Wellknown examples include Alexander Cruden’s The London-Citizen Exceedingly Injured (1739), John Perceval’s A Narrative of the Treatment Experienced by a Gentleman, During a State of Mental Derangement (1838, 1840), Clifford Beers’ A Mind That Found Itself (1908), Mary Jane Ward’s autobiographical novel The Snake Pit (1946), and Kate Millett’s relatively recent The Loony-Bin Trip (1990) about her involuntary commitment to an asylum in Ireland. Occasional narratives by those who were not mad but who were nonetheless confined to mental asylums are valuable for the corroborating accounts they provide: for example, William Seabrook’s Asylum (1935) and Janet Frame’s An Angel at My Table (1984), as well as her autobiographical novel Faces in the Water (1961), report much the same conditions and abuses as chronicled in the other works. Many therapies once believed to be efficacious have been abandoned, sometimes in response to narratives of protest by former patients. Charlotte Perkins Gilman, for example, who was subjected in 1887 to S Weir Mitchell’s “rest cure”, during which she was forbidden to write or engage in any intellectual activity, wrote the fictional story “The Yellow Wallpaper” (1892) based on her experience. Although she originally had difficulty finding a publisher for the work, it has since become a feminist classic. In her commentary (1913) about why she wrote the story, Gilman reports that “many years later [she] was told that the great specialist [S Weir Mitchell] had admitted to friends of his that he had Autobiographical accounts of mental illness have for centuries provided a fascinating window on the world of madness for those fortunate enough never to have sojourned there themselves. Even with all the advanced brain-imaging and other technologies of medicine, the subjective experience of mental illness can be conveyed only by those who have lived it. Yet the nature of the experience poses immense challenges for any author, for the very faculties required to construct a narrative— perception, memory, and reason— can be profoundly altered by illnesses such as depression, bipolar disorder, and schizophrenia, as well as by treatments such as electroconvulsive therapy (ECT) and psychotropic drugs. Perhaps as a result—or perhaps just to avoid the stigma of being identified as a mental patient—contemporary authors have sometimes chosen to present their accounts as fiction. Whatever their choice in this regard, the desire to make sense of what has happened to them, the wish to reform abuses in the treatment of the mentally ill, and the hope of helping other patients and their families have been powerful motivations for the hundreds of patients who have written about their experiences of mental illness. How these authors make sense of what happened during their episodes of mental illness has changed substantially from one age to another. In earlier centuries, mental illness was often understood and portrayed as demon possession, to be treated by exorcism or other religious interventions. If these remedies failed, trials and executions for heresy and witchcraft sometimes followed. Indeed, early autobiographical accounts of mental illness have been compared to spiritual autobiographies in their concern with the religious dimensions of the inner life. In The Book of Margery Kempe (c 1436), which many regard as the first such autobiographical account in the English language, Kempe describes her first experience of mental illness, which today might be called postpartum psychosis, as visions of devils tempting her to commit wicked deeds and to forsake her faith. More than two centuries later, the Bavarian artist Christoph Haizmann recorded in his diaries and in a series of paintings his story of the devils that he believed were responsible for his eight episodes of madness (figure). Autobiographical accounts representing mental