Many people with delusions, especially if they are poor, will see police officers a lot more often than they’ll see a sympathetic doctor. That was true in Paris and London in the eighteenth and nineteenth centuries and it’s still true.
Most of our subjects found doctors who wanted to listen and bothered to record the conversations. They leave us a rich legacy. But after following these life stories from the past, which are inevitably incomplete, we lose the trail and the first question is: did the delusions continue? We do not discover for certain if a person was cured long term, or what sort of life they had after their time in hospital, when they set off back down those dimly lit streets. We are left with snapshots from their lives, out of context, and the odd scene stands out, crystal clear and memorable in an otherwise fragmented and impenetrable life story. We pick up touching personal traces as we go: signatures and marginal notes in the admission ledgers and birth and marriage certificates. We see a name on the page in a particular hand, wonder if it’s really their signature, and feel sad when we spot a matching name has ‘moved to the incurable’ part of the hospital, or a sense of joy on the rare occasion we see a release date. Each of these case studies has gaps in the story, and we can’t know what’s really going on in the sufferers’ minds or what undiagnosed biological factors there may have been. Attending to the words and images in the delusion itself offers the best chance of detecting a true-life story.
Many of the physicians from the past did understand, in one way or another, that if they pulled up a chair and listened as their patient told their story, it did seem to help. Sitting with someone who is experiencing a delusion, venturing some of the way into their world, even if it’s through a ruse, can forge a connection. They may not come back from that alternative world, but they will share, confess. Even ruses or ‘white lies’ could succeed, for a time, as with ‘Léa-Anna B’ and her letter to the king. There’s an essential dignity in what each of them is asking for – that we consider their most profound needs: to be worthy of attention and interpretation and to be reconciled with their circumstances. The lives of these individuals span six hundred years, but they have a lot in common. They all want to find some peace, respectability, love. Standing next to each other in this book they each have something to say to each other as whispers of solidarity pass between them, and to us.
Delusions are very articulate in their own right. ‘Madame M’ turns the loss of her children and her sense of alienation into substitute doubles who stalk her around Paris looking just like her and her missing children. Another woman’s total bewilderment is communicated with consummate eloquence in a letter in the persona of ‘Madame Bonaparte’. She invites her husband ‘Napoleon’ into her inner life where magnificence, real suffering, intimacy, alienation and all sorts of other contradictory sensations co-exist. She can’t find the words, she says, and yet she does find the words, dressed up in her ‘delusion of grandeur’. Clothes become important in all of these stories – hats, uniforms – because delusions are all about telling people how to view you and how to treat you. In many ways, delusions are a game of dressing up.
With delusions, the messages themselves are clear. They give form to dizzying ambiguity and confusion, whether that form is a king made of glass, or the proud family tree of a disgraced servant displaying multiple scions of European royalty, or a body with no guts or brain. There’s artistry and dignity in the endeavour, and dignity is not something that people experiencing delusions have traditionally been allowed much of.
What’s behind them? At a psychological level, low self-esteem, excessive worry, trauma, and, in the case of paranoia, isolation are contributory factors. A feeling of belonging vaccinates against delusions.
Other themes have also stood the test of time: money, love, war, uncertainty, shame, social anxiety, technological progress and, above all, inner conflicts, be they personal or religious. Delusions offer escape from a wretched situation; they repackage wounded pride, humiliation, or shame at the hands of lovers or neighbours.
Delusions sit at the intersection between neurology, and psychology, and different causes frequently co-exist within the same individual, overlap and fuse. We can see that many of these people in the historic cases were experiencing several different ‘types’ of delusion at the same time. Minds are not neat, and, thanks to neuroscience, we now know that, with many delusions, organic brain disease exists alongside psychological causes.
Each new frame for delusion in the centuries that follow tells us something important about man’s place in the world at that time. In the literature of the classical world, the gods had the upper hand over mortals, controlling even their delusional follies by proxy. Then the Christian God took charge of the Western world and religious authorities quickly decreed a link between delusion and demonic possession. From then, right up until the nineteenth century, it was religion that decided the fate of the people experiencing delusions. Since then, diverse medical and psychological disciplines have had a go at interpretating the phenomenon, argued over it, filled in some of the blanks. Psychoanalysis prized them as creations born out of childhood experiences that had lodged in your unconscious mind. Biological psychiatry in the 1960s and 1970s downgraded delusions again to evidence of how a diseased brain jumbles things up and, as it were, spits them out. We haven’t solved it yet.
We all have at least one belief about the world or ourselves that the others who know us well would not agree with. We are all somewhere on the scale, most, of course, not as far up it as the individuals featured in this book.
It’s clear, though, that many delusions are helpful to us, can even be critical to our psychological survival. Again and again, delusions organise the enemy and give us a very clear purpose which might be, for example, to expose a treacherous conspiracy, or get the king to admit that he has stolen the throne that is rightfully ours, or demonstrate that despite our sense of alienation we have in fact been loved passionately for years.
People cling to delusions as a life raft. Be they Charles VI of France in the fourteenth century casting himself apart from the crowd wrapped in blankets, or Robert Burton a little later on navigating the dark sea of his life with reference to the stars of his horoscope. You can’t therefore reason someone out of a delusion by explaining why it’s not true. It’s their best chance of survival.
At this particular moment in history, at the beginning of the third decade of the twenty-first century, paranoid delusions in the form of conspiracy theories have taken an even firmer hold on sections of the global population, and they, too, simplify a complicated world. Uncertainty faces most of us at points in our lives, and always has, but some people are better able to accommodate ambiguity than others. Some just aren’t equipped to tolerate it.
The conversations between the subject and the doctor in this book spark with symmetries and sympathies. The physicians are attempting to understand and cure their patients and at the same time trying to find their own equilibrium, their own way through, many having hard, first-hand experience of war. On the surface they couldn’t be more different. The points of contact are touching and, sometimes, every bit as intriguing as the delusions themselves.
Delusions are creations of the imagination, and they demand attention much like pieces of performance art, or raucous protests. They are forged out of inner conflict and they do a lot of work for us, organising and articulating perfectly ordinary wishes and fears, expressions of anxiety and suffering. Above all they are protection from an unbearable reality; not so much a ticket out of town as a regeneration and rebranding of the old one. They give shape to a chaotic inner life. They allow us to disconnect and check out. They puzzle and haunt us. They are at one and the same time completely understandable, and utterly mysterious.
Acknowledgements
I’m indebted to the clinicians whose work I’ve read and who I’ve spoken to over the course of writing this book who have helped me orientate within the many different disciplines involved in this unwieldy subject over the centuries.
I owe particular debt to Professor Daniel Freeman, clinical psychologist at the University of Oxford, who is pushing an ever more nuanced understanding of brain and mind and with whom I made a series in 2018 for BBC Radio 4. He led a series of conversations for the programmes with people who generously shared their personal experience of delusions. I admired his skill and empathy and what I learned from these contemporary conversations was invaluable in helping me notice patterns, and understand more about the people in this book who experienced delusions a long time ago in the past. Heartfelt thanks also to all the people who told their stories.
Eve Streeter produced the BBC Radio 4 documentary series with me. A great friend and I’ve learned so much from her great skill and sensitivity over many years working together making radio documentaries.
My interest in delusions really began when I spoke to Andy Lameijn in Leiden about glass delusion. I’m grateful for his generosity in sharing his experiences with me, not to mention his time, and for giving me the three antique volumes of Robert Burton’s The Anatomy of Melancholy, which I treasure and dip back into for inspiration daily. It’s an intoxicating subject and it’s been marvellous and sometimes head-spinning to explore – I’ve been happily lost in each of these worlds, with ten new companions to show me around who have intrigued and entertained me, sometimes led me astray, and frequently moved me. They feel like friends now.
Mary Ann Lund’s work on Robert Burton and melancholy in the early modern period is second to none and has been an invaluable resource and inspiration both for the radio series and the book. My conversations with Adam Phillips about glass delusion fired my interest and guided my thinking. I owe a great deal to Laure Murat for her painstaking research which unearthed so much from the archives in the making of her political history of madness.
Mike Jay and his body of work got me hooked on James Tilly Matthews and the Air Loom and The Influencing Machine which sets the bar for scholarship of Matthews.
I’m also grateful for my conversations with Andrew Scull around the history of madness and delusion, about which no one knows more.
Andrew Hussey’s writing about Paris gave me a passion for the darker side of the city’s streets and made me want to return to them. Hallie Rubenhold’s The Five introduced me to forgotten lives in Victorian London. Hilary Mantel’s novel A Place of Greater Safety transported me to the French Revolution and introduced me to people I hadn’t met before and now feel as if I know. Horatio Clare’s riveting account of his own experience and his investigations into treatments, Heavy Light, was a game changer.
I’m enormously grateful to Emily Lutyens and Kate McCrickard for painstaking research in the Paris archives while the city was in lockdown, for batting the subject to and fro over the Channel, and for the extraordinary articles, photographs and postcards they found for the book.
Richard Bentall’s research on paranoia has been both fascinating and really helpful and Professor Edward Shorter, a historian of psychiatry from the University of Toronto, gave me an overview of the history of psychiatry, and specifically catatonia. Thanks are due to friends and colleagues for lively discussions along the way; to Joby Waldman and others at Somethin’ Else, and BBC Radio 4 for support getting the documentaries on air.
I owe a great deal to my agent Luigi Bonomi for championing the book in the first place and for all his encouragement.
I’m so very grateful to Richard Collins and to Polly Hatfield and Rida Vaquas at Oneworld for their careful and clever readings of the text and everyone who has had a hand in getting the book together and into such beautiful shape: a dream team.
At home, Mohit and my parents and wider family, Jo Spence, Nora Rose and Esmee, thank you for entertaining the little one while I wandered off into other centuries with these intriguing characters.
Above all to Sam Carter, my brilliant editor at Oneworld. His support, guidance and enthusiasm for the subject has meant everything.