History of Psychiatry

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French psychiatrists on the causes of madness, 1800-1870: an ambiguous

attitude before an epistemological obstacle
Laurent Sueur and Andrew Hodgkiss
History of Psychiatry 1997; 8; 267
DOI: 10.1177/0957154X9700803005
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History of PsychIatry,

v1i

Pnnted m England
267-2
(1996),, 267-275.

French psychiatrists on the causes of madness,

1800-1870: an ambiguous attitude before
an epistemological obstacle
LAURENT SUEUR*
Edited by
ANDREW HODGKISS

Modern psychiatry was born in the late eighteenth and early nineteenth
centuries. At that time French psychiatrists had much to learn. One of their
interests was in recognizing the causes of madness which they divided into
physical and moral. This article aims to describe this moment in the history of
medicine and to demonstrate how ancient ideas were reworked by these alienists.
Above all it is argued that alienists struggled with a kind of disease that was
regarded as unacceptable at the time.

Thirty
madness. He

published his book on the history of

emphasized the oppressive manner in which insane people
were confined during the eighteenth century. That book was the starting
point of social history of psychiatry in France and many followed in
Foucaults footsteps. However, some themes were not dealt with by
historians: because of a poor knowledge of source materials many only
studied the age of Pinel and Esquirol (1793-1840) and neglected other
psychiatrists of that period. I have chosen here to deal with the discovery by
French psychiatrists between 1800 and 1870 of some of the causes of
years ago, Michel Foucault

madness. I shall try

to

show the birth of the scientific mind in the age of

positivism.
physical causes of madness
Ancient physicians thought that insanity was caused by physical disorder. At
the beginning of the nineteenth century, when psychiatry and modern
1. The

* Address for correspondence: 126, rue des grands champs,

75020 Paris, France.

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268

medicine

bom,~ physicians thought

that madness originated from

and the inhalation of stale air: we must bear in mind that
scientific modern medicine developed from such generally accepted ideas.
But if the archaic medical mentality was evident at the beginning of the
period, as the century advanced science was increasingly used to question
these long-held truths. Nineteenth-century French psychiatrists became
more scientific through considering the role of poisoning - and especially
poisoning with alcohol - in the aetiology of madness.
Alcohol was not yet regarded as a substance that destroyed the French
social system. Nobody considered prohibition, and physicians were not
advocating such a measure as yet. Moreover, interned people would drink
some alcohol : one litre of cider per day for a woman, and one and a half litres
for a man, at the Bon Sauveur of Caen. When Bergeret - chief physician of
the hospital at Arbois (in the Jura mountains) - published one of the first
serious books about alcoholism in 1870,4 he stated that the substance was not
dangerous but that its excessive use was; he even said it was a medicine, a
tonic. His attitude was not unique, many of his colleagues used alcohol as a
tonic and as an antiseptic. If physicians did not condemn the use of alcohol,
they were aware that its excessive use could lead to delirium tremens. This
disease was well known: psychiatrists knew its cause, and its symptoms were
described in many books and articles. But French alienists went beyond the
field of alcoholism and acknowledged that an overdose of alcohol could be
the cause of various types of madness. Hence, Prost thought that alcohol
abuse was one of the causes of mania;5 Macario, of demonomania,6 Gillet, of
monomania and Brachet, of hypochondriasis. Thus psychiatrists generalized
from the recognition of this one real pathological factor, reasoning that since
alcohol was a cause of delirium tremens, and this delirium was a type of
madness, then alcohol must be one of the causes of all types of madness.
This supports the view that these alienists considered madness a sufficiently
coherent morbid entity to admit a single pathological factor.
Other toxins were considered. Neurological disorders are seen in cases of
poisoning by mercury, lead, and other metallic substances. This led alienists
such as Terrier to suggest that certain types of insanity with rather similar
symptoms, like epilepsy, could have the same cause. Many believed that the
use of narcotics could engender insanity. They used opium and its byproducts in the medical treatment of insanity and so knew that it was a
dangerous substance and were even aware of its hallucinogenic effect. Morel
used to stop giving it when patients were suffering from hallucinations.&dquo; In
1854 Baillarger characterized one sort of mental disease caused by the abuse
of narcotics.&dquo; Similarly, in 1859 Morel subdivided the mental diseases
caused by poisoning into several divisions: the first concerned narcotics.&dquo;
While some alienists saw narcotic abuse as a type of madness, others believed
that an overdose of opium could cause different sorts of insanity:
demonomania according to Macario3 and melancholia according to Gachet.4
were

digestive disorders

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269
Macario noted that eating datura, or thorn apple (which contains atropine)
was another cause of demonomania ;15 in fact, the substance is an

hallucinogenic drug.
Some considered that the ingestion of corrupted breast milk could cause
madness. According to Belhomme/6 when a mother suffered vivid mental
impressions while breast feeding she gave her baby a substance causing
insanity. He believed the mental impressions left a physical trace in the
maternal milk: a kind of unknown poison. Cerise held a similar view and
followed Boerhaaves reasoning, who had described a baby who became
epileptic after sucking milk from a wet nurse suffering violent passions. He
emphasized this observation:&dquo; ... Tissot has noticed that wet nurses who
take wine produce &dquo;a state of frantic mobility&dquo; in the children they breast
feed....
The malfunction of an organ was also regarded as a cause of insanity. In
this respect nineteenth-century French psychiatrists merely extended and
systematized ancient medical ideas. According to Esquirol, skin diseases
could breed madness. IS Some thought that a physical lesion of the nerves and
polyemia could breed epilepsy.&dquo; According to Belhomme, a blow to the
foetus could cause idiocy later.o In 1861, Lisle stated that heart disease
could be the starting point of insanity.21 Brachet wrote in 1844 that local
diseases were the first step towards hypochondriasis.22 These physicians had
studied physical disorders of the body before specializing in psychiatry:
Hippocratism and anatomy led them to think that any disease, whether
mental or not, was characterized by a change for the worse of the living
matter. As late as the early twentieth century, psychiatrists had difficulty in
accepting that insanity could not be caused by a physical disorder.
Nineteenth-century medical materialism can be further illustrated by
studying French psychiatrists views about the role of the female reproductive
organs and of the brain in the aetiology of madness.
Since ancient times, physicians have carefully studied the matter
emanating from the human body ; and nineteenth century French alienists
did so as well. Some regarded all menstrual bleeding as pathological:
according to Macario, it could breed demonomania23 - epilepsy according to
Delasiauve.24 Others regarded menses as pathological only when the flow was
over- or under-abundant. For instance, Corlieu25 and Brachet stated that
women had good reason to become hypochondriacs, the reason being :26
... the menstrual disorders,
abundant or suppressed leucorrhoeas, ... .
This attitude stemmed from Galenic theories : menses and leucorrhoeas were
regarded as fluxes, and flux disorders caused insanity by reacting on the
brain.
In another vein, some alienists considered womens reproductive organs as
linked to hysteria. Thus, in 1846 Landouzf7 stated that the crisis point of
hysteria was connected with the stimulation of womens genitals : hence, the
brain (that is to say the mind) was injured through the nervous system. This
...

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270

opinion depended on the ambiguous attitude towards womens sexuality in

nineteenth-century France. No scientific theory could acknowledge or
accommodate such a thing. Many believed that women, being deeply fond of
sex, were at risk of insanity; especially if they indulged in abnormal (i.e. nonprocreational) sexual activities. This image of the hysterical Eve was the
result of the incorporation of religious and macho prejudices into medical
science. As early as 1817 Bouneau28 warned that hysteria was not an
exclusively female disease and was often independent of the womb, but this
was not the majority view at the time.
Little was known about the brain in this era. The localization of its
functions remained unknown despite Galls research; in fact, Broca only
discovered the area of verbal expression at the end of the century. 21 However,
everyone would admit that the brain was the biological substrate of
intelligence and sensitivity. Since madness was characterized by the loss of
reason and intelligence and by misperception of objects, French physicians
concluded that mental diseases depended on a brain lesion. Very few
psychiatrists dared to reject what was regarded as a pathological fact. It was
difficult to oppose these widely shared ideas. For instance, in 1829
Belhomme wrote:3 ... Does madness depend on irritation or vital lesion of
the brain? We must admit that it depends on a lesion, because the analogy
compels us to think that there is no lesion of a function without a lesion of
the corresponding organ.... This simple reasoning was not supported by
physical proof, but some tried to find such evidence. For example, Terrier
wrote that head injury could result in epilepsy.3 Joseph Artaud32 considered
that idiocy sometimes arose from incomplete development of the brain;
hence, intelligence depended upon the size of that organ. For Hatin,33
epilepsy was principally caused by a momentary accumulation of blood in the
encephalon; it was only differentiated from apoplexy by its lesser intensity.
This belief in the organic and cerebral origin of madness drove Billot to
declare:34 ... with the exception of the mental disorders of general paralysis,
we do not always find perceptible lesions of the brain; for all that, we do
think there is an organic alteration in madness: it is a mathematical truth....
He added:35 ... It is well substantiated that there is an organic change in
every normal or abnormal phenomenon.... These two sentences illustrate
that French alienists had a good knowledge of the cerebral alterations of
general paralysis (syphilis) since Bayles research and that some psychiatrists
were still much influenced by the Hippocratic theory which stated that the
cause of all diseases was a physical lesion. But not all nineteenth-century
French psychiatrists accepted that all kinds of madness were caused by an
alteration of the encephalon. For instance, Parchappe noticed there was an
alteration of the brain in general paralysis while nothing was manifest in
epilepsy. Hence, he wrote that in epilepsy there was nothing in the brain that
could be regarded as a pathogenic factor of the disease.36 Briquet stated in
1859 that hysteria was not characterized by a lesion of the encephalon.&dquo;

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271
Some psychiatrists believed that insanity could be passed from parents to
their children. Manuel Leven stated in 1861 :38 ... Congenital idiotism is
essentially a disease that runs in the family, and we find it in families which
include insane people, epileptics and paralytics ... Idiotism is a diathetic
disease that develops in some isolated valleys of the highlands.... It is
generated by the filth in which the inhabitants of these valleys live, and it is
maintained by interbreeding.... Populations were sedentary during the
nineteenth century. There were not many roads in the French mountains and
the inhabitants of the valleys had few relations with the outside world: the
pedlar would expect the snow to melt before he came, some shepherds
brought news from the neighbouring villages but there were very few visitors.
Such small, isolated communities were characterized by strong inbreeding.
Hence, when a member of the community suffered from an hereditary
disease (Downs Syndrome for instance), that community was rapidly
affected by the disease. Morel gave the best example of this problem.39 In the
middle of the nineteenth century, he studied a region in the Meurthe where
many people were suffering from myxedema (that is, goitre). One Marie
who was intelligent but had been suffering from myxedema since the age of
30 - married Joseph, a semi-cretin who suffered from congenital myxedema
(his father and grandfather were also semi-cretins). They had many
children; six were still alive when Morel wrote his book, and four of them
were seriously affected by congenital myxoedema. Hence, Levens opinion
about the heritability of what he called congenital idiocy (a notion that
included congenital myxoedema and Downs Syndrome) was close to reality.
Moreover, we notice that the theory of degeneration, described recently by
Daniel Pick, was not only defined by social arguments: it also had a scientific

basis.&dquo;
French alienists also believed that other mental diseases were heritable.
Berthier wrote:4 ... Many mental diseases are the result of weak semen,
which is the indispensable intermediary between the decay of the body and
the decay of the mind.... Berthier did not say precisely what these mental
diseases were, but according to Corlieu melancholy was a disease that could
run in the family.42
2. The mental

causes

of madness

causes were not regarded as the only pathogenic agents. From the
of the century psychiatrists argued that passions could breed madness,
this being another legacy from ancient medicine. For example, Philippe Pinel
quoted Ciceros Tusculanes.43 Nevertheless, it should be recognized that
French alienists did more than repeat old theories: they redefined the
concept of dangerous passion in their own way.
The passion that most preoccupied them was love. According to Falret,44
this passion generated madness when there were family quarrels, especially

Physical
start

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272

between husband and wife. Macario45 and Brachet46 dealt with frustrated
love. Fod6r6 wrote in 1817 :47 ... Love is cured by orgasm: it generates real
diseases only when it is frustrated.... French alienists were sometimes more
society men than scientists, few were impartial on the topic of sexuality and
many wrote books and articles full of generally accepted ideas. What, then,
were their subjective opinions about sex?
At the beginning of the century Esquirol wrote:49 ... At the time of
puberty, the new organs breed new needs and feelings; consequently, the
Thereafter, insanity - unknown
young man is attacked by new diseases;
until then - disturbs the first days of adult life; it takes adolescent passions as
its model: it is vehement, furious, amorous and acute unless he has abused
himself in a most reprehensible way. In that case, his intellectual and physical
faculties are weakened. The result is premature senility: then he suffers from
hypochondriasis, dementia, idiotism, which are the signs of his approaching
death.... Womens passions are more vivid, animated and erotic....
According to Esquirol, when the genitals begin functioning (at the time of
puberty) they generate love; therefore the cause of that passion is physical.
We must not forget that nineteenth-century physicians did not distinguish
between love and sex. Clearly the adolescent who masturbated was heading
for disaster: first he became a lunatic, then he died. As for women, they
particularly suffered from erotic passions which bred madness: in Western
Europe, sexuality and femininity have been linked since ancient times. By the
end of the eighteenth century, the image of the sexual Eve was so strong that
some women did not oppose this widely accepted idea; Baroness Stael of
Holstein wrote in 1796:50 ... Love is the only passion of women;
Love is
the whole story of womens lives, it is a little episode in mens lives....
Consequently, two images of the insane by love appear : woman and the
adolescent. Anceaume&dquo; agreed with Esquirol that it was at adolescence that
the passion of love appeared; therefore it was then that one most risked
developing erotic melancholy (that is to say, the disease of carnal love).
Anceaume stated that the end of womens sexual life could breed
melancholy: can we regard this as the beginning of a description of the
mental disorders of menopause? In the opinion of Casimir Pine1:52 ... The
men who over-indulged their sexual fancies during childhood, who
fornicated a lot when young, who still stimulate the genitals even when they
are growing old ... are not very sensible people, consequently they are in
danger of developing serious diseases, especially nervous and cerebral
disorders.... He argued that madness was not only caused by masturbation
in adolescence; its origin could be found in excessive sexual activity
throughout a mans life. It should be noted that this sexual activity was not
necessarily deviant: the fornication could be between husband and wife.
Most nineteenth-century French alienists believed that men had to preserve
their semen in order to save their strength. Sex was thus alienating for Pinel
and many of his colleagues.
...

...

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273

Governments were also regarded as causes of insanity. Anceaume dealt

with this in his book on melancholy :53 ... Liberal governments - that is to
say, governments which are a successful miscellany of democratic, aristocratic,
monarchical principles - most allow people to express their passions;
consequently, they breed most mental diseases and melancholic disorders.
This is mankinds destiny: human beings cannot strive for happiness without
striving for unhappiness. The worst government (that is to say the despotic
government) breeds least insane people: it is a little compensation for the
disorders it breeds.... The revolutionary era was just over when he wrote
these sentences: he must have seen different governments functioning. When
he spoke of democracy, aristocracy, monarchy, despotism, he spoke mainly
from experience; but there is also an intellectual reference to Montesquieu
and ancient authors. For him, the alienating governments were those which
allowed the passions to be freely expressed. Such governments bred passions
and aggravated them. This opinion was widely shared among French
alienists and as late as 1860, Berthier could writer ... The government that
allows ambitions to be expressed breeds arrogance, doubt and suicide....;
suicide was regarded as a mental disease. This sentence shows the strength of
belief in the danger of passions. Some physicians, like Berthier, thought that
children must be educated in such a way that their passions were not totally
allayed but controlled.55 Were they led to hold such opinions because they
were fervent anti-democrats? Unfortunately the paucity of sources does not
allow us to answer that question.
Other passions were also regarded as pathological agents. For instance
religious passions,56 jealousy, frustrated ambitions, humiliated pride,
dishonour, shame, anger, fears, remorse and reverses of fortune.5
It is now clear that early nineteenth-century French psychiatrists relied on
archaic concepts; they had not rejected Hippocratism and classical
philosophy and were still very subjective with regard to sexuality: it must be
said that they had not yet become scientists. French psychiatry was still prepositivist from 1800 to 1870. Nevertheless, we do not accept Ian
Dowbiggins view58 that these alienists were foolish, Machiavellian people
who only wanted to keep their social privileges by pretending to discover the
causes of madness and thus show their competence. Above all, it has to be
borne in mind that nineteenth-century French psychiatrists attempted to
understand insanity though with limited intellectual means, unlike their
predecessors who waited for the verdict of nature. Henceforth, they were
deeply involved in the improvement of mankinds mental health. They were
like others in the nineteenth century who rebelled against poverty,
maltreatment of humans and animals and who wanted to create a world
where reason and humanity (two eighteenth-century concepts) reigned until
the end of time.

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274
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1997 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.