A mad, mad world

Delusions are among the most striking features of some forms of serious mental illness. In such cases, claims about reality that seem quite bizarre to others are held on to with remarkable tenacity. Those in their grip are impervious to the ordinary correctives that lead the rest of us to modify or abandon false beliefs.

The loss of contact with the reality most of us think we share can create enormous disturbances to the texture of daily life, not just for the person in the grip of delusion, but for everyone around them. When our solution to mental illness was to consign people to madhouses and asylums, giving voice to one’s delusions was a sure pathway to being shut up, in the double sense of locked away and silenced. But even in the time before the rise of segregative responses to madness, and in the contemporary era of community care, knowledge of these strange inner worlds is all too often elusive and evanescent. Inevitably that means that the task of constructing a history of delusions faces almost insurmountable difficulties.

Victoria Shepherd’s approach to the subject is to eschew any attempt at a linear history. When John Haslam, the apothecary at Bedlam in the early nineteenth century, published a detailed account of the elaborate delusions entertained by one of his patients, James Tilly Matthews, he called it Illustrations of Madness. Shepherd’s “history” might more appropriately be called “Illustrations of Delusions”, for what she provides is a series of sketches, culling from the historical record striking examples of individuals in the grip of delusions, one of whom, not surprisingly, is Matthews.

His is an unusual case because his thoughts were reproduced at great length by the man in charge of his confinement. Haslam thought that Matthews’s own words were the best evidence of his insanity. An educated man and a superb draughtsman (his designs for a new Bethlehem Hospital were, in a nice piece of irony, awarded a special prize by the institution’s governors), Matthews told an elaborate tale of plots and persecution, of conspiracies and intrigues involving French revolutionaries and the British government, with himself at the center of the action. Heed his mind was being controlled by a nefarious gang who insisted who influenced his thoughts through mesmeric rays and mysterious gases that were also being used to dupe politicians and threaten Britain with revolutionary terror. And he provided elaborate drawings of the Air Loom, the contraption that exerted this marvelous form of thought control, and explained in minute detail how it produced its effects.

Historians of psychiatry have long known of this case, not just because of its lurid features, but also because Matthews has often been hailed as the first recorded case of schizophrenia, and because, in a bizarre twist of fate, his testimony helped bring about the collapse of the regime at Bedlam, including the firing of Haslam and of his nominal superior, the physician to the hospital, Thomas Monro. And, thanks to Mike Jay’s remarkable reconstruction of Matthews’s life before, during and after his confinement (The Air Loom Gang, 2003; republished in enlarged form as The Influencing Machine, 2012), we have long known that his delusions were rooted in his real experiences in Paris after the French Revolution, including a stent locked up in a series of prisons during the Great Terror, at grave risk of being executed as a spy. It’s a fascinating tale, full of twists and turns, and Shepherd summarizes it well and at length. But it is not clear that she adds much to what others have already told us about this strange man.

Shepherd chooses to open her account with the case of Madame M, an anonymous woman who is presented as the exemplar of another kind of delusion, known after the psychiatrist who recorded her symptoms as Capgras syndrome. Madame M claims that her husband has been replaced by a series of doubles. Other looksalikes have been substituted for other members of her family. And abducted children are being held captive in the bowels of her house, screaming that they need to be rescued.

These are the first two of a series of historical vignettes that make up Shepherd’s book, and their presentation out of temporal sequence – Madame M.’s delusions date from the years after the First World War, Matthews’s from the Napoleonic Wars – is characteristic of the rest of the book. We are next invited to consider the life of the great seventeenth-century chronicler of melancholy, Robert Burton, whose unstable mental state is the starting point for an earlier exploration of the imaginary worlds some solitary souls come to occupy. The omnium-gatherum that is The Anatomy of Melancholy in turn supplies Shepherd with notable examples of delusions to explore. She re-examines the life of Francis Spira, a Venetian put on trial in 1548 for heresy, who publicly renounced his Protestant faith to avoid being burnt at the stake, only to be seized by a sense of dread. Believing that he had damned himself for all eternity, he fell into despair and starved to death. And she retells the story of Charles VI of France, who in the late fourteenth century developed the delusion that his entire body was composed of glass. Charles VI was scarcely the last to embrace this particular delusion, as Burton documents, and related delusions abounded, such as the baker he records, who believed that he was made of butter and would melt if he approached his ovens.

We are next plunged into the Georgian age and the story of Margaret Nicholson, a poor seamstress who imagines herself the rightful Queen of England and seeks to reclaim her throne by stabbing George III with a butter knife. As Shepherd points out, Nicholson suffered a very different fate from that of Robert-François Damiens, a deluded Frenchman who ineffectively stabbed Louis XV in 1757. Damiens was tortured, torn limb from limb by horses, his body eviscerated and then cast into the flames While he was apparently still conscious. Nicholson was deemed mad and carted off to Bedlam, where she managed to outlive the monarch she had assaulted and became a prominent tourist attraction.

Four shorter chapters choose stories that exemplify other prominent kinds of delusion. There is the Parisian clockmaker in the years of the Great Terror, obsessed with constructing a perpetual motion machine, who observes the consequences of another technological innovation, the guillotine, and promptly decides that he has lost his own head, which has been replaced by someone else’s. Shepherd retells stories of delusions of grandeur, exemplified by a host of men – and the occasional woman – who imagine themselves to be Napoleon (a chapter drawn from the pioneering work of Laure Murat). And we learn of Madame X, a patient in a Parisian asylum during the belle époque who is convinced that she is dead – a walking corpse who embodies a delusion, Shepherd reminds us, that Robert Burton had already encountered. And finally there is erotomania, a delusion apparently more common among women, as exemplified by a French woman in the 1920s who is convinced King George V is secretly in love with her, and travels repeatedly to London in a vain attempt to consummate the affair.

Shepherd cautions us that we must not “mistake these stories for a collection of dusty curiosities from a long-lost past”. And it is true that she makes valiant attempts to connect the various delusions she discusses to the lives and losses of the characters she writes about. But even though these are bizarre and extreme cases, and thus people about whom we know far more than we do about most historical cases of delusions, it proves hard to move beyond what is trite and obvious. More often than not, Shepherd is forced to speculate. Phrases such as “she would perhaps”, “we may imagine”, “it is conceivable”, “presumably” and so on are common.

In A History of Delusions, Victoria Shepherd has given us an entertaining glimpse into the tragic world of delusions. But it is hard to see that she has achieved her larger ambitions. As we finish this collection of tall but real tales, “we loop around again to the perennial and knotty question of what delusions might mean.” And we are no closer to an answer.

Andrew Sculll‘s latest book, Desperate Remedies: Psychiatry and the mysteries of mental illnesswas published in April

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