The Man Who Couldn’t Stop (6 page)

Historians have since questioned the truth of Freud's account of his success with Lanzer (it is the only case for which the famous doctor's original notes survive). Frank Sulloway, a psychologist at the University of California, Berkeley, who has revisited much of Freud's work, has concluded that: ‘The Rat Man – cured or not – was clearly intended to be a showpiece for Freud's nascent psychoanalytical movement.' Certainly there are discrepancies between Freud's notes and his subsequent write-up. Lanzer's treatment seems to have lasted for a few months, rather than the full year that Freud claimed in his reports. And there are doubts about whether Lanzer was helped as fully as Freud insisted – doubts that are impossible to investigate given that Lanzer's death prevented any long-term follow-up, by Freud or anyone else.

Freud was far from the first medic to record irrational and obsessional thoughts and behaviours. Others before him were interested in these unusual states of mind and their reports had already started to converge on common symptoms. The first medical case study of this new age – the patient zero of OCD – was not the Rat Man, but a young French woman from the early nineteenth century known as Mademoiselle F.

She was, the mademoiselle remembered, about 18 years old when her curious behaviours began. It is doubtful that anybody around her noticed at the time. Her odd action was nothing more noteworthy than to take one of her regular visits to the house of her aunt without her apron. She did not forget it. She had always worn her apron on such visits before, but on that day she chose quite deliberately to leave it at home.

Her curious thoughts had started some time earlier, on her previous visit to the same house. This time, we can be certain that nobody else noticed, for she was already on her way home when the idea struck her with no warning and no provocation. What if she had stolen something from her aunt? What if the loot was somehow concealed in the folds of her apron? The solution, she later recalled, was obvious. She would not wear the apron again.

The curious thoughts, and the curious behaviours, continued. The mademoiselle, a tall woman with auburn hair and blue eyes, worked as an accountant. She was honest and worked hard, but she began to fear that she would somehow wrong her clients. She took longer to prepare accounts and invoices as she was forced to check her sums and her records. Her concerns grew more intense and made her reluctant to handle money, in case she retained some in her fingers. And what if her fingertips could somehow drain value from the coins and notes that passed through them? Was that not another way for her to cheat those who trusted her? It was an irrational worry, she knew, but she decided that the most sensible course was to give up her business.

By now, the thoughts that plagued the mademoiselle were not a secret. Her friends protested. If she stole some money, they said, she would know about it. And the contact of her fingers could not alter its value. That is true, the mademoiselle would reply, my preoccupation is absurd and ridiculous. But I cannot prevent it. Without work, the concern broke beyond its boundaries and flooded into her everyday life. She cut the hems from her dresses and wore her shoes so tight that the skin from her swollen feet gathered in bunches above, to keep her from placing stolen items inside. She held her clothes when she walked in hesitant steps so they did not brush against doors and furniture. And she scrutinized the keys, knobs and handles of windows and wardrobes with forensic duty; all to prevent the transfer to her of anything of value.

Years passed. Frustration and exasperation took root as she exhausted the inadequate advice of her friends and relatives, as well as her own reason. Her fears, and the behaviours she followed to ease them, sometimes faded, but they always returned. Some sixteen years after she first laid aside her apron, the mademoiselle, exhausted and bewildered, headed for Paris in 1834 and committed herself to the care of the renowned psychiatrist Jean Etienne Dominique Esquirol.

Esquirol was director of the Charenton lunatic asylum, a centuries-old institution on the banks of the Seine that previously held the writer and libertine Marquis de Sade. From a wealthy background in Toulouse, Esquirol had studied at the influential Salpêtrière hospital in central Paris, where he went on to launch and teach a course in mental disorder, set up in the hospital's dining hall. As well as his position at Charenton, Esquirol ran a private clinic – a
maison de santé
− in the nearby village of Ivry, where affluent patients would pay ten or fifteen francs a day for care. ‘To see madhouses risen to such extraordinary prices,' a Paris newspaper said of Esquirol's clinic in 1827, ‘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.'

Mademoiselle F had stayed with Esquirol for two years by the time he wrote of her case. She was, he said:

… never irrational; is aware of her condition; perceives the ridiculous nature of her apprehensions and the absurdity of her precautions; and weeps at and makes sport of them. She also laments, and sometimes weeps in view of them.

Even in the
maison de santé
, the mademoiselle still guarded against her feared thieving. ‘Before leaving her bed,' Esquirol wrote,

 

… she rubs her feet for ten minutes, in order to remove whatever may have insinuated itself between the toes or beneath the nails. She afterwards turns and returns her slippers, shakes them, and hands them to her chamber-maid, in order that she, after having carefully examined them, may assure her that they conceal nothing of value. The comb is passed through the hair a great number of times, with the same intent. Every article of her apparel is examined successively, a great number of times, inspected in every way, in all the folds and wrinkles, and rigorously shaken. After all these precautions, the hands are powerfully shaken in turn, and the fingers of either hand rubbed by each other. This rubbing of the fingers is performed with extreme rapidity, and repeated until the number of rubbings, which is enumerated in a loud voice, is sufficient to convince her, that nothing remains upon them. The close attention and uneasiness of the patient are such, during this minute exploration that she perspires and is almost exhausted by the fatigue of it. If, from any cause, these precautions are not taken, she is restless during the whole day.

The woman went to the theatre and on trips home to see her family. She ate and slept well. In many ways she was the life and soul of the residential clinic. Each night she would join others in the drawing room, and her conversation was ‘gay, humorous and sometimes mischievous'. The only outward sign of her inner torment came if she was forced to switch seats, or if she inadvertently touched her head or dress, or the chair of another. Then she would rub and shake her fingers.
*

Esquirol said her condition was a form of monomania, or partial insanity – a concept he developed and promoted, which argued the mind could be unbalanced by a single train of thought. Someone with monomania was mad, at least partly mad, but they were aware of it. Only a part of their brain and so a specific function was affected, the rest was normal.

The concept of monomania, framed as the obsessive pursuit of an idea, caught the public imagination – as shown by its prevalence in literature written at the time. The memorably dark characters Heathcliff in Emily Brontë's
Wuthering Heights
(1847) and Raskolnikov in Dostoyevsky's
Crime and Punishment
(1866) are both described as monomaniacs. Perhaps the most famous depiction of monomania was Herman Melville's Captain Ahab, who was consumed by a single-minded madness to kill the great white whale in
Moby-Dick
(1851).

Monomania had many types, which Esquirol and his followers used to explain a range of unusual, antisocial and illegal behaviours. They made the biggest impact in the field of law. Denied the status in society they felt they deserved, Esquirol and his cronies used monomania to gain control of the medico-legal process used to assess the sanity of defendants in the French courts – which at the time often came down to a friend or neighbour who would turn up and say that a murder suspect who claimed insanity had always seemed fine to them.

With monomania as their lever, French psychiatrists forced their way into public discussion of several grisly murder cases that captivated Paris in the early nineteenth century. In 1828, for instance, a servant girl called Henriette Cornier went on trial for the sudden and inexplicable murder of her employers' small child. Cornier, said one medic called by the defence, was a monomaniac propelled to kill, and so should be considered legally insane.

The debate crossed the channel to London with a young French man called Louis Bordier, who was convicted of the murder of his girlfriend and sentenced to hang at Horsemonger Lane gaol in October 1867. At the time, Britain still executed some condemned prisoners in public, and the gallows at Horsemonger Lane were more public than most, set up on the roof of the gatehouse at the front of the gaol. Charles Dickens had been so horrified at the scenes at one such execution of a husband and wife there in 1849 – watched by a claimed crowd of 30,000 people – that he wrote a famous letter of protest at the death penalty to
The Times
.

With Bordier just days from his date with the noose, Dr Harrington Tuke, the honorary secretary to the British Medico-Psychological Association, wrote an emotional plea for clemency in the medical journal
The Lancet
. Bordier, he said, was a monomaniac.

If he be hung the cruel absurdity will be committed of inflicting capital punishment upon a lunatic, and fixing upon his kindred the unjust stigma of relationship to a responsible and cold-blooded assassin.

To support his case, Tuke pointed out that Bordier had listened to the jury's guilty verdict and to the judge deliver the death sentence with ‘stolid indifference' and deaf to the wailings of his two little girls, had walked unconcerned from the dock.

The appeal made no difference: Bordier was hanged the following week – the final execution held in public at Horsemonger Lane. His death did not finish the arguments over his state of mind. A response to Tuke's letter from the surgeon of Newgate gaol, just across the River Thames, who had examined Bordier – and whom Tuke had criticized – appeared a fortnight later. Bordier's conduct in the trial, the surgeon said, did not support the claim of madness, even partial madness:

When his eldest little girl was placed in the witness box, he bent his head so low as completely to hide his face from the observation of any one in court, as if he could not bear the glance of his own child, or bear to look upon her.

The glance of a child would one day prove pivotal in my life too.

*   *   *

When I found that I could not make my irrational thoughts of HIV go away, I spent a lot of time on the phone to the National Aids Helpline. I would ring them from the phone box at the side of the busy road opposite the house into which six of us had moved at the start of the second academic year. I would call to tell them how the fears that I had of the virus had spread, and about all of the extra ways my thoughts now told me that I could have caught the disease. It felt good to say those things out loud. It was a relief to free them from my head and expose them to the light. Was there, say, a risk when I played soccer and scraped my knee along the abrasive Astroturf? Someone else could have done the same after all, and left a smear of infected blood at that exact spot. No, they would respond, no need to worry. The risk was very low.

Thanks, I would say as I blew out my cheeks − that's reassured me. I might even have believed it, for just as long as it took to replace the handset and turn to leave the phone box. But, wait, very low? The risk was very low, so there was a risk? Shit, what if I hadn't explained what happened exactly right. They might have misunderstood. The risk could be higher if they realized what really had happened. I should call back, just to confirm. I would dial the number dozens of times a day. Sometimes I would hang up before they answered. I couldn't understand why my mind would circle round, why the sense that everything would be all right was so fleeting.

The National Aids Helpline, I quickly worked out, was staffed by about half a dozen people at any one time. I learned their voices, and was encouraged when someone new picked up the phone – surely they would be the one to convince me. After a while, they started to recognize my voice too, and my feared situations. That was bad. They would tell me that they had already given me an answer and that I needed to accept it. I didn't want that. I wanted the hit. Tell me I am not infected. So I invented new scenarios, just similar enough to real ones to bring that familiar flicker of comfort when they were dismissed. And, sorry National Aids Helpline workers circa 1991 and 1992, but I disguised my voice. I even put on different regional accents. I'm sure you knew. Not that it did any good. Reassurance, like offence, is taken not given. And my mind would not take it.

Every night HIV was the last thing I thought about before I went to sleep. And it was the first thing I thought of every morning. And it was pretty much all I thought of in between. I have few memories from that time of anything else. I lost interest in the stuff that had seemed important just a few months previously; music, books and films no longer held my attention. I no longer cared how other people's stories ended, for I could no longer identify with anyone else's trivial concerns. What did it matter, really, if this man in a hospital drama had hurt his leg? If I had HIV and I broke my leg, then I would still have HIV when they fixed it. I had a rival narrative in my head in which the stakes just seemed so much higher than anything that went on in life outside.

I decided to donate blood. They would test for HIV. My anxiety spiked as they pierced my skin with the needle but then, as I watched the thick red fluid pour from my arm, a plastic cup of orange squash waiting on the shelf, I felt not fear but a surge of exhilaration – oh, I should have done this ages ago! Of course there was nothing in my blood; no virus was slowly eating away at my cells, my promise and my future. They would tell me I was all right and I would believe them.