In her haunting short story “A Door Swings Open,” Maud Casey offers a glimpse into the infamous “era of soul science” at the Salpêtrière hospital in Paris throughout the latter half of the nineteenth century. There, famed neurologist Jean-Martin Charcot and his colleagues attempted to advance knowledge and treatment of “hysteria” and other mental disturbances through a series of extreme, abusive experiments on subjects who were mostly young, female, and socially isolated. These practices were extensively documented in medical photographs taken in the hospital and demonstrated before audiences in Charcot’s popular “Tuesday Lectures,” with outsized attention given to a few patients whose behavior most clearly conformed to, or could be made to conform to, the doctors’ theories. Others were deemed hopeless cases. Casey’s forthcoming book, City of Incurable Women, from which “A Door Swings Open” is adapted, imagines the lives of these young women, the individual details of which have largely been lost to the historical record. In December, she discussed this project with GR managing editor C.J. Bartunek by email.
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C.J. Bartunek (CJB): “A Door Swings Open” extends some of the themes developed in your previous work. Readers of your novels will recognize that the experiments done in the Salpêtrière hospital also figure in The Man Who Walked Away . In other works, such as Genealogy , you have depicted contemporary characters encountering today’s constructions of mental illness and prevalent understandings of treatment. To say that the Salpêtrière doctors’ treatment of patients violates later norms of medical ethics would be a gross understatement, but in The Man Who Walked Away, one doctor visiting an exhibition featuring disturbing treatment of a young women in the throes of an onstage “attack” thinks back to the recent past when patients with mental illness were routinely kept in chains. How did these doctors and scientists understand the work they were doing? In what ways do you see the legacy of the late-nineteenth-century practices you describe manifesting today? Is there a twenty-first-century equivalent to what those doctors called “hysteria”?
Maud Casey (MC): As so often happens, one book led me down a rabbit hole, which led to another rabbit hole, and another, which led me to my life in the rabbit warren of nineteenth-century psychiatry and its discontents. I’m always wary of fiction writers speaking with great authority on historical subjects, and yet I’ve become increasingly interested in imagining my way in between the lines of history, specifically the history of the perception, treatment, and depiction of minds in extremis, and so, well, I have some thoughts.
First, I should say that Ian Hacking, a scholar, historian, philosopher, and provocateur, has been my guide from the beginning. His Mad Travelers: Reflections on the Reality of Transient Mental Illnesses  was what led me to the case history of Albert Dadas, which became the inspiration for The Man Who Walked Away. The capacious bibliography in the back of that book, and Hacking’s thinking across some of his other books about the construction of diagnoses and their emergence for nationalistic, political, and cultural reasons in certain historical eras was revelatory. That reality of the transient nature of mental illnesses he describes means “hysteria” came and went as a diagnosis, as will many of our contemporary diagnoses. (And yet it is often used casually, without many of us giving a lot of thought to its etymological origin, the Greek word hystera, or uterus, and so, wandering womb—and so, has it disappeared entirely?) Hacking articulates the difficult questions about the history of psychiatry—the ways it went awry and its good intentions; the amorphous nature of psychic pain and the shapes it takes, or is molded into, that are then replicated in what he describes as “symptom pools”; the usefulness of diagnoses within systems (health insurance!) and the increasingly reductive nature of diagnoses. I’m forever pointing to his 2013 op-ed in the London Review of Books, “Lost in the Forest: Who Needs the DSM?,” written in response to the controversy around the current edition of the Diagnostic and Statistical Manual of Mental Disorders. In it, he describes the DSM being founded on “a wrong appreciation of the nature of things.”
What is the right appreciation of the nature of things? I’m not sure I know, but how to tell a story that might run alongside the historical record is compelling to me. Fiction allows for a different appreciation of the nature of things. Among other things, it allows for the exploration of that secret history of the texture, the warp and weft, of an inimitable consciousness. In relation to, say, a nineteenth-century French man who wandered, lost, bereft, ecstatic (as in the case of Albert Dadas) or the women and girls who ended up, by virtue of having no other options, in Jean-Martin Charcot’s late-nineteenth-century Salpêtrière, each with their own amorphous pain, performing the diagnosis of hysteria. I’m inventing my way into these long-lost scenes, out of curiosity, affinity, longing, and a desire to be in conversation with these people. Desire, that engine, is, of course, a lack. I will never actually have that conversation. Still, desire tugs me along, as it will.
CJB: In the essay you cite, Hacking notes that one group highly critical of the DSM used today is “skeptical about the very project of standardized diagnosis, especially of schizophrenia and bipolar disorders. More generally, it opposes the biomedical model of mental illness, to the exclusion of social conditions and life-course events.” Your story seems attuned to that tension. The young women who make up the choral “we” of “A Door Swings Open” have largely been marginalized by poverty, sexual assault, the deaths of their parents, or other trauma before their respective entries into the hospital. Then, within the hospital, they feel further exclusion due to their inability to make their symptoms conform to the doctors’ hypotheses as those of “the best girls” do. Though in their present situation they are lumped together at Salpêtrière under the label hysterics, which as you say is highly gendered, you suggest the range of their personal histories, which of course also included experiences of happiness, pleasure, and love. Would you talk a bit about your choice of the first-person plural for this story and about the possibilities in general you see in this particular narrative mode?
I was also struck by your statement in The Art of Mystery: The Search for Questions that “Stories are how we stand in the presence of mystery. If mystery, the genre, is about finding answers, then mystery, that elusive yet essential element of fiction, is about finding the questions.” What questions were foremost in your mind as you approached The City of Incurable Women?
MC: These questions are entwined for me so I will entwine my answers! Standing in the presence of mystery, and finding the questions, or crashing around looking for them, is what interests me in fiction, and, well, everything. It’s where I want to go when I write and when I read and when I live. Same when I encountered the historical lives of these women, these girls. The medical scene at the time was finding answers for them (hysteria), which had a lot to do with their circumstances and their gender. Imagining my way into some parallel universe of these lives, inspired by their biographies, was a way to unravel the knot, the so-called answer, of hysteria. There is no simple math for our minds, for what we like to call the self. I wanted atmosphere versus a corrective. Impressions and, most of all, the inimitable texture of a particular consciousness (the glimpse of that strange, elusive thing fiction offers). Happiness, pleasure, love, yes, for sure, and, too, those flashes of ineffable and fleeting experience. Those seemingly inconsequential moments that are, in fact, consequential, because these make up so much of a life. It’s my effort to appreciate the right “nature of things,” to use Hacking’s phrase; maybe right isn’t exactly right. Maybe it’s my effort to appreciate the glorious messy mess of things?
“A Door Swings Open” is part of City of Incurable Women, which will be published by Bellevue Literary Press. The book is an assemblage of portraits, with archival images, inspired, in part, by the Iconographie photographique de la Salpêtrière, the three-volume medical reference book produced by Désiré Magloire Bourneville and Paul Regnard, students of Jean-Martin Charcot, between 1876 and 1880. The Iconographie photographique grew largely out of Charcot’s work with those patients he diagnosed as hysterics; it was meant to provide forensic evidence of a disease that, in essence, said—shocker!—women had something implicitly, physiologically, wrong with them. Alongside case studies, the Iconographie photographique contains so-called objective documentation in the form of 119 black-and-white photographs of women in various stages of hysteria. Jacques Lacan once wrote, “Where are the hysterics, those magnificent women of former times?” Was he being ironic? Who knows? When I first read that question, I was intrigued. I thought, well, they are everywhere. They are still with us. They are us. I also thought, oh, shut up, Lacan.
City of Incurable Women is a sideways answer to his sideways question. In the book I played with a lot of different perspectives. For some of the more renowned hysterics—Louise Augustine Gleizes, known in the amphitheater by the Madonna/Rihanna one-name moniker “Augustine,” or Marie Wittman, known as “Blanche”—first- or third-person seemed right; for others, a direct address seemed a better way to suggest curiosity (on my part), a desire to know, a conversation, or an effort at conversation that might reach across the centuries. But of course a conversation isn’t possible. There’s always been, for me, an element of wish fulfillment in fiction. Among many other things, it’s a space of possibility. In “A Door Swings Open” and a few other sections in the book, first-person plural felt like the best way to create a sense of solidarity between those women and girls not anointed by Charcot, whose names have been lost to the dustbin of history but maybe not to one another, as well as a sense of their singularity. That was my hope anyway—to create an imagined community, a chorus, made up of many I’s.
CJB: “A Door Swings Open” refers at a few points to the photography studio at Salpêtrière. What has happened to those photographs? What is known about the two we see here?
MC: Some are collected in various archives in France, and here in the United States—there’s a collection of digitized photographs at Yale’s Harvey Cushing/John Hay Whitney Medical Library and a cache of glass photographic plates at the Countway Medical Library at Harvard. The photograph called Catalepsie is a photograph of Augustine in what appears to be a nurse’s outfit. She entered Charcot’s Salpêtrière when she was fourteen and escaped many years later dressed as a man. That’s the last anyone knows of her, or cared to know of her.
The photograph with the writing on the woman’s chest is a result of something called dermagraphism. A doctor would “write” the name of the patient, trace it lightly, or sometimes the name of the hospital, the woman’s diagnosis, and the date, on the patient’s skin. Sometimes the words appeared, according to the doctors, spontaneously, as a symptom of hysteria; sometimes it was acknowledged that the words were traced on the patient’s back and the raised skin spelling out the words was the result. It remains something of a mystery, as do aspects of the photographs of women diagnosed with hysteria.
The technology of photography at the time—the photographic plates, the length of exposure time—required, well, time, which suggests the photographs required not only staging, but perhaps an element of cooperation with the patients (they would need to hold poses in order for them to be captured clearly in the photograph). Asti Hustvedt’s Medical Muses: Hysteria in Nineteenth-Century Paris  is a wonderful resource for this era and all that went down. I turned to it, and its bibliography, again and again. I highly recommend it for anyone interested in this particular moment of psychiatric history, as well as for a historical account of the lives of the women in the photographs. My fiction is deeply interested in, beholden to, that history, but it’s not history. It’s what I’d call fact adjacent.