Article by Anne Picard

On January 28, 1846, three of the world’s leading authorities on madness convened to assess the mental health of Gaetano Donizetti.  Philippe Ricord, the American-born expert in the treatment of venereal disease, Juste-Louis-Florent Calmeil, author of De la folie, considerée sous le point de vue pathologique, philosophique, historique et judiciaire, and Jean Mitivié of the Pitié-Salpêtrière hospital had been engaged by Donizetti’s nephew, Andrea, following reports of the composer’s increasingly erratic behaviour.  Their conclusion was as expected: the composer of the most famous mad-scene in operatic history had lost his reason, succumbing to the delusions, convulsions and terrors of tertiary syphilis.  Duped into believing he was on his way to Vienna, Donizetti was bundled off to an exclusive clinic in Ivry-sur-Seine, where he would remain for 17 months and 23 days, first frightened and confused, then insensible and dull-eyed, before Andrea took him back to Bergamo to die.

In an age obsessed with medicine, syphilis was the disease no-one wanted to talk about.  Instead, consumption and hysteria dominated 19th century conversation, spreading like a contagion to opera.  The symptoms of both conditions were documented and disseminated in public lectures, sentimental paintings and photographs, romantic and realist novels, popular song and sensationalist theatre.  The language of mental and physical disease infiltrated the arts with uncommon alacrity, from Berlioz’s idées fixes to Balzac’s casual use of the term ‘monomania’ (first used by the alienist Esquirol in 1810), Flaubert’s self-identification as a hysteric, Zola’s interest in moral degeneracy and the neurasthenic songs of the café-concerts (Alice de Tender’s ‘La Parisienne épileptique’).

At the Pitié-Salpêtrière, the neurologist Jean-Martin Charcot drew crowds of artists and journalists to his weekly lectures on hysteria, illustrated by patients who would demonstrate the paroxyms and attitudes passionelles of their condition under hypnosis.  Among Charcot’s students were Sigmund Freud and Alfred Binet, who wrote plays for the Grand Guignol theatre including The Laboratory of Hallucinations and A Crime in the Insane Asylum.

The depiction of altered states and altered bodies became an obsession of 19th century opera.  Sleepwalking was the modish subject of Bellini’s 1831 opera La sonnambula, derangement the focal point of Donizetti’s Lucia di Lammermoor in 1835.  Predating Bellini and Donizetti, the Naples-born, Paris-trained composer Michele Carafa had the distinction of writing both an opera on somnambulism, Il sonnambulo (1824) and an adaptation of Sir Walter Scott’s novel, Le nozze di Lammermoor (1829).  This was more than excuse for fioritura.  Where madness in 18th century opera had largely been episodic or comedic, with lucidity restored in time for the final coro, in the 19th century it became an end in itself, fuelled by the morbid fetishes of the Gothic movement and a fame-hungry, press-savvy medical community.  In Bellini’s I puritani and Il pirata, and Donizetti’s Linda di Chamounix, the earlier model persists; in Lucia, there is no such resolution.

Later, Ambroise Thomas tapped into decades of  Ophelia-mania in his Hamlet, while Jacques Offenbach, German-born but more French than the French in his musical ironies, made the automaton Olympia a bel canto cataleptic and tinged the consumptive Antonia with hysteria in Les contes d’Hoffmann.  As time passed the obsession shifted from mental illness to physical.  Based on two mid century literary sensations, Alexandre Dumas’s La Dame aux camélias and Henri Murger’s Scenes de la vie de bohème, and written either side of Robert Koch’s discovery of mycobacterium tuberculosis, Verdi’s La traviata and Puccini’s La bohème continued this operatic fascination with ailing women.  Founded by Jean-Etienne Dominique Esquirol, the maison de santé Donizetti was confined in at Ivry-sur-Seine was celebrated for its luxury, its 25 acres of grounds, its billiards and bathing rooms, and its innovative single-storey design.  As early as 1827, the Journal de Paris floridly posed this question of Esquirol’s private clinic in Paris: “Who has not heard about the excellent treatment that the doctor gives to lunatics, the care and attention of which they are the object? But who does not also know that it is impossible to be admitted for less than 10 or 15 francs a day? To see madhouses risen to such extraordinary prices, one would be tempted to believe that insanity is a privilege and that, without being a bureaucrat or a capitalist, it is inadvisable to rave.”

Writing in the April 1846 edition of the Journal of Insanity, the American physician Isaac Ray admired the asylum in his “Observations on the Principal Hospitals of the Insane in Great Britain, France and Germany”.  On the treatment of private patients in France, he observed that “…they have no communication… with the paupers, occupying rooms in a different part of the house, and furnished with accommodation in any style of expense they are willing to pay for.  The charge for this class is often as high as two or three hundred guineas per year, for which they have a suit [sic] of rooms handsomely furnished, private attendances, carriages, and even gardens appropriated exclusively to their own use.”

Donizetti had set a one-act romantic comedy (I pazzi per progetto) in a Paris asylum only five years before he adapted Scott’s novel.  It is not known whether he had cause to visit one before his own confinement, but in the mad music of Lucia there is an almost clinical precision to the writing, extrapolated by librettist Salvadore Cammarano from just a few terse words in Scott’s original.  It was the French feminist critic Catherine Clément who first noted the similarity between Lucia and Charcot’s hysterics.  Reproduced in the footnotes to the second volume of the Iconographie photographique de la Salpêtrière in 1876-1877 (to the apparent disgust of the British Medical Journal’s reviewer), Désiré-Magloire Bourneville’s verbatim records of the delirious fantasies of Augustine Gleizes, a young hysteric under Charcot’s care, echo Lucia’s ravings: an ecstatic encounter with the unseen beloved, the sensation of a kiss on her cheek, terrifying hallucinations of violence.  This seems to have been the first time any doctor had bothered to publish what the hysterics were saying about their own condition, in their own words.

Like a coloratura soprano impersonating the role of Lucia, Augustine was, in a sense, performing, for her delirium was induced, stage-managed, observed.  Born to a humble family, she is unlikely to have known Donizetti’s opera, though she may have understood through popular culture (and the example of her fellow patients) what the performative conventions of madness were.  Hysteria, the symptoms of which were seemingly infinite – from tics to paralysis, laughter to tears, excessive eroticism to frigidity, aural or visual hallucinations – could be applied to any troublesome daughter or wife, any termagant or rebel.  At the Salpêtrière, however, it conferred a higher status than mere madness – better treatment, better accommodation, more attention, even fame, a license to misbehave, albeit mediated through the theatre of Charcot’s lectures.

The impact of Esquirol’s investigations into alienism in the early decades of the century was soon felt in the courts.  By the time of the Paris premiere of Lucia in 1839 several murder trials had been overturned on grounds of insanity.  In opera, too, an altered state absolves any transgression.  Just as Amina is revealed as blameless when she is observed to be sleep-walking in Bellini’s opera, Lucia escapes censure for murder.  Like the instrument that accompanies her delirium, the glass harmonica, with its disturbingly unmediated touch of moistened fingers to glass, Lucia is both delicate and dangerous when broken, but, being broken, she can have no responsibility for her actions.  In any case, she pays dearly enough, dying of a broken heart.

Back in the real world, the hysterics of the Salpêtrière lived a remarkably ordered life.  In Notices on the Lunatic Asylums of Paris (1844), Dr John Conolly commends the hospital’s 50-bed dormitories “whose exquisite neatness would excite the envy of a New England housewife”.  Ray remarks on the quietness therein and the “extraordinary treatment of delusions with the cold douche”.  Tongues contracted to the ping of a tuning fork, bodies arched over thin air, arms and torsos scratched with names and dates by doctors researching dermographism, hands reaching seductively to invisible lovers or resisting imagined assailants in the five volumes of dreamlike photographs that made up the Iconographie, the patients of the Salpêtrière were as pathetic and pliant as any operatic heroine.  The hysteric was, as Elaine Showalter has written, “an idealised, poetic form of pure femininity as the male culture had construed it: absolutely irrational, absolutely emotional, and…  absolutely passive”.  Derangement also afforded a view of the female form at its most uninhibited: the thrusting pelvis of the arc de cercle, the orgasmic cries of the hysterical paroxysm.

The to-and-fro between theatre and hospital during Charcot’s 33-year reign as the “Napoleon of neuroses” was remarkable.  The case of Jane Avril, the Salpêtrière hysteric who recovered to become a celebrated dancer at Le Chat Noir, is one obvious example.  Less well-documented is the cross-fertilisation of performance behaviour between patient and artist.  Sarah Bernhardt is said to attended Charcot’s Tuesday lectures, while his most pliant patient, Blanche Wittmann, one of three women whose cases are examined in Asti Hustvedt’s Medical Muses, was hailed as a diva to rival Bernhardt.

With fame came notoriety.  The medical establishment was anxious to distance itself from mesmeric showmen and hypnotising hucksters, not least because of persistent suspicions that Charcot’s most famous patients were faking.  Far from silencing Charcot’s critics, the publication of the Iconographie compounded the problem, for even with state-of-the-art equipment, the stars of the Salpêtrière would have had to have held their poses for several seconds or leave only a blur.

The investigation of hysteria – or hysteroepilepsy, as Charcot termed it – would dominate Paris for nearly a century before moving to Vienna, then slowly disappearing.  An illness that for much of medical history was assumed to be caused by a ‘wandering womb’ simply vanished.  Charcot believed the cause to be somatic, an effect of lesions in the brain, though sexual frustration, masturbation, the excessive consumption of chocolate and even the reading of novels were variously thought to induce hysteria.  Parents anxious to secure decent husbands for their daughters paid close attention to the latest theories.

Lucia, of course, is the victim of a forced marriage, whereas Violetta and Mimì, (like Silvia, the heroine of Mascagni’s Zanetto) enjoy a sort of independence, albeit one purchased at the ultimate price of respectability.  Young women were expected to be physically and emotionally delicate, malleable; so to be alluring in the 19th century, even as a courtesan, was to be – or appear to be – gravely ill.  Sales of rouge plummeted as the tipo traviata became fashionable.  As Dumas noted “it was good form to spit blood after any emotion that was at all sensational and to die before reaching the age of 30”.  Since tuberculosis was responsible for half the deaths of the under-25s, and a third of the deaths of those aged between 25 and 45, the chances of attaining that special glow by natural means were relatively high.

As contagion was not understood until 1881, we should perhaps not be surprised that the physical appearance of a disease associated with an early death had sexual potency, almost a rock ‘n’ roll cachet (at least among the literati who read Dumas and Murger and visited the opera or the Salpêtrière: it is doubtful whether a working-class Parisian would be quite so intoxicated by the tipo traviata).  Both consumption and derangement came with the heady myth of heightened sensuality.  Both Violetta and Mimì have moments of sheer delirium in their operatic incarnations, the gasps of joy or renewed vigour that presage death.  In La traviata (1853) and La bohème (1896) the reactions of the heroines’ lovers, both from a middle-class background, reflect a wider change in reactions to consumption: Verdi’s Alfredo expresses no fear of infection from Violetta, whereas Rodolfo is transparently terrified of Mimi’s failing health by Act 3 of Puccini’s opera.

In John Everett Millais’s 1878 portrait, The Bride of Lammermoor, the two most iconic female types of the century converge.  Here is Lucy the mad virgin, unable to walk without support and sporting the pale skin, slender limbs, heavy lids and ‘hectic flush’ of the

consumptive.  More potent even than Henry Peach Robinson’s much-exhibited 1858 photograph of a dying consumptive, Fading Away, Millais’s painting idealised weakness.  No wonder Carmen seemed out of place when she burst on the scene in 1875, all sun-tan and cigarettes.

Middle-class hysterics visiting their family physicians would be recommended hydrotherapy, a rest-cure, perhaps the purchase of one of the electric massage machines whose history as a cure for hysteria is related in Rachel Maines’s entertaining study, The Technology of Orgasm: Hysteria, the Vibrator, and Women’s Sexual Satisfaction.  Women of Lucy Ashton’s stock, the elite of hysterics, would have to wait until the end of the century to return to the clinical spotlight, when Freud and Breuer published their Studies on Hysteria.  But with the publication of Freud’s work, the concept of womanhood changed forever; and, following suit, the neurotics of 20th century opera would be more extreme, polymorphously perverse, shrill or near-mute: Lulu, Salome, Elektra, Mélisande.

The backlash after Charcot’s death in 1893 was sudden and severe, as his pupils hurried to distance themselves from his methods and theories.  His rehabilitation, not so much as a physician but as a cultural figure, came from the strangest of sources, the Surrealists – André Breton and Louis Aragon hailing hysteria as “one of the most poetic discoveries of our epoch” in 1928, making Augustine an icon once more.  Sadly, like Charcot before them, the Surrealists seemed more interested in Augustine’s appearance than in her story, just as we are more interested in the melodies that remain from two now marginalised diseases and the ghosts of a deranged bride, a celebrated courtesan and a shivering grisette.

So what do we hear when we hear Lucia, Violetta and Mimì today? For Catherine Clément, lauding and mourning opera’s consumptives, sleepwalkers and suicides in her controversial 1979 work, Opera, or the Undoing of Women, it is a glimpse of eternity.  “One must know the truth about hysterical women,” she writes in her conclusion: “… they have bodies filled with memory, they tell the truth about oppression, they bore holes in the family, they are right with delirious reason… The opera will not succeed in getting to the end of it.  And in these indefinitely repeated murders, it is killing dead women who have already come back to life.  The matches blaze again and the sky lights up once more…  Just as you always stretch your arms when you leave the darkness, these women will always sing.”

Anna Picard worked in the field of early music before turning to journalism. Since 2000, she has been the Classical Music Critic of the Independent on Sunday.