Doctors’ Orders

In the summer following the death of Leslie Stephen in 1904, his daughter Virginia lay in bed, listening to the birds singing in Greek and imagining King Edward lurking naked in the azaleas, shouting obscenities; that same summer she apparently attempted to kill herself by leaping out of the window. ‘I have never spent such a wretched 8 months in my life,’ she wrote to a friend when the crisis had passed.

And yet that tyrannical, and as I think, shortsighted Savage insists upon another two ... really a doctor is worse than a husband! Oh how thankful I shall be to be my own mistress and throw their silly medicines down the slop pail! I never shall believe, or have believed, in anything any doctor says – I learnt their utter helplessness when Father was ill. They can guess at what’s the matter, but they can’t put it right.

Twenty-one years later, her fictional ex-soldier, Septimus Warren Smith, hears the sparrows sing in Greek, believes that his best friend, killed in the war, speaks to him from behind the trees in Regent’s Park – and prefers death to doctors. Hearing the dreaded Dr Holmes about to burst into the room, Septimus flings himself ‘vigorously, violently’ out of the window, to be fatally impaled on the railings below. ‘It was a subject that I have kept cooling in my mind until I felt I could touch it without bursting into flame all over,’ she wrote to Gwen Raverat. ‘You can’t think what a raging furnace it is still to me – madness and doctors and being forced.’

Stephen Trombley does not quote this letter, but ‘madness and doctors and being forced’ crisply sums up the contents of his own angry book. Much of his study concentrates not on Virginia Woolf herself but on the views of several physicians who were consulted in her case (including the fortuitously named Savage), and who clearly inspired her bitter caricature of the profession in Mrs Dalloway. These were the ‘conventional men’ whom Woolf recalled in a letter to Ethel Smyth of 1930, men whose chief response to their patient’s suffering had been to forbid work and exercise, to insist on isolation, weight gain, and extended rest in bed: ‘ “you shant read this” and “you shant write a word” and “you shall lie still and drink milk.” ’ With its ban on reading and writing, Woolf’s summary of her doctors’ orders constitutes a literary patient’s version of the ‘rest cure’, 19th-century medicine’s fashionable solution to the problems of middle and upper-class women. As feminists have recently argued, it was a method of treatment which was itself pathological, an exaggerated prescription for female passivity and immobility. Trombley has relatively little to say about the implications of such ‘cures’, though he does speculate briefly on the various drugs with which Woolf may have been sedated and the symptoms which they might in turn have produced. While he obviously deplores the handling of her case, the focus of Trombley’s outrage is not the treatment of Woolf’s madness but the diagnosis itself. Arguing that the doctors in question were incapable of distinguishing medical judgments from social and moral ones, that ‘the manner in which Virginia’s madness is discussed by Leonard Woolf, Quentin Bell or the editors of the Letters and Diary shows that their use of the term is at best uncritical, and at worst irresponsible,’ Trombley sets out to show that there is no ‘concrete evidence’ that Virginia Woolf was mad. Or, to quote an early and ringing declaration which in fact claims considerably less than its note of resolute defiance might suggest: ‘As I hope to show by the end of this book, the Virginia Woolf of Three Guineas was perfectly sane.’

The general direction of Trombley’s argument is not new. In her chapter on Woolf in A Literature of Their Own (1977), Elaine Showalter perceptively noted the complicity of the novelist’s husband and sister in her illness, and contended that ‘madness was the role in which she articulated her resentment and rage’ against them. Showalter wisely refrained, however, from suggesting that the patient’s madness was therefore nothing but justified rage. In Roger Poole’s The Unknown Virginia Woolf (1978), the picture of a conspiracy around Woolf was far more thoroughly and relentlessly developed; both Poole’s central argument – whose premise was that once we understand the causes of Woolf’s behaviour, ‘crude and offensive’ words like ‘mad’ no longer apply – and many of the particular bits of evidence he adduced closely anticipate Trombley’s own. The Unknown Virginia Woolf was seriously marred by hyperbole and special pleading, but it offered many acute observations about the meaning and context of Woolf’s suffering – and compared to Trombley’s book it was a model of reasoning and tact. Though he was hardly as clear or consistent on the point as he should have been, Poole at least seemed to argue that what is troubling about words like ‘madness’ or ‘lunacy’ is their connotations of the utterly mysterious and alien, that to label someone ‘insane’ can too easily be a way of distancing and dismissing rather than understanding them. Trombley, in contrast, keeps conjuring up the very demons he wishes to exorcise from Woolf’s history. The idea of ‘madness’ this book invokes is so primitive, the state implied by the term so absolute and inhuman, that it is no wonder Trombley wishes to preserve Woolf from its name.

‘It is my belief that the attribution of madness is a serious matter, not unlike a judgment of criminal guilt,’ Trombley writes. The comment has the fashionable aura of R.D. Laing, Thomas Szasz and Michel Foucault, but although he makes vague gestures at all three, Trombley does not seem to comprehend the implications of their arguments. For what follows from his comparison of madness and crime is the conclusion that Virginia Woolf should be considered innocent until proven guilty – a verdict that only makes sense if the ‘guilt’ of madness could ever be convincingly proved. ‘No one has made a truly scientific medical study of Virginia Woolf,’ he asserts, and ‘until concrete evidence is produced, it is irresponsible to speak of her as having been mad.’ On the other hand, no ‘truly scientific medical study’ with ‘concrete evidence’ can be performed on the dead, from which it presumably follows, though Trombley does not say so, that only the living can ‘responsibly’ be called mad. Because he writes as if a truly scientific medical study of madness were a genuine possibility, and because he fails to distinguish between the argument that insanity is always a social fiction and the claim that Virginia Woolf in particular was not insane, Trombley differs radically from the social critics of medicine with whom he appears to identify.

Trombley characteristically argues that Woolf was not mad because even her more severe symptoms ‘make sense’ – by which he seems to mean that we can understand why she should have hallucinated birds singing in Greek or believed that Leonard and the doctors were conspiring against her. The sense he makes of such symptoms is nearly all Roger Poole’s. As everyone interested in the novelist now knows, her recently published autobiographical essays record several incidents from childhood and late adolescence in which she was sexually molested by Gerald and George Duckworth, the Stephen sisters’ half-brothers by their mother’s first marriage. Poole drew on these memoirs, on a letter in which Woolf recalled George Duckworth ‘fondling’ her over her Greek lessons, and on the abundant evidence of her intense and life-long ambivalence toward the study of Greek (an uneasy mixture of reverence for the ideal rationality it represented and anger at her exclusion from the Classical education accorded Leonard and her brothers), to argue persuasively why Greek should have mingled with the obscenities of a naked king in the language of her hallucinations. Poole also offered a cogent explanation for the recurrence of the hallucinations in her breakdown of 1913, when she was sent by an apparently unsuspecting Leonard to recuperate in the country house of the very half-brother who had earlier staged the unwelcome sexual invasions of her language lessons. The belief that the sort of detective work in which Poole engaged can uncover the origins of mental symptoms is a fundamental tenet of our modern, post-Freudian faith. But to argue, as Trombley does, that Woolf’s hallucinations were not mad because their sources can be thus traced is to reverse the compassionate direction of Freud’s thought, to imply that genuine madness would be beyond all human comprehension and help. The irony is that Trombley’s hapless attempts to defend the novelist end up perpetuating an extraordinarily simple and troubling myth of what true madness would entail. ‘The ravings of a mad woman?’ he asks rhetorically after quoting a passage from Three Guineas. The answer is obvious, but typically begs the real question: the power and lucidity of Woolf’s writing are only evidence that she was not ‘mad’ if we assume that the truly mad would be for ever incapable of recovering their sanity.

To find Trombley’s logic muddled is not to endorse the moral and intellectual confusions of Woolf’s doctors. Medical men like Sir George Savage and Sir Maurice Craig freely compounded their psychological and social prescriptions. Trombley is understandably critical of the looseness with which Savage, for instance, alluded to the ‘morally insane’, one of whose distinguishing features seems to have been a lack of respect for inherited social position. In his indignation at their failure to be scientifically objective, however, Trombley fails to acknowledge that any psychological judgment – even that there is no insanity – is shaped by moral and social values: what is really troubling about Woolf’s doctors is that their values were significantly at odds with her own. T.B. Hyslop, whose advice Leonard sought on whether Virginia should bear children, is perhaps the most glaring example:

It is true that the more our women aspire to exercising their nervous and mental functions so they become not only less virile, but also less capable of generating healthy stock. Now not only is this a question concerning the virility of the race, but it has very direct bearings upon the increase of our nervous instability. In fact, the higher women strive to hold the torch of intellect, the dimmer the rays of light for the vision of their progeny.

Hyslop elsewhere made chilling allusion to his countrymen’s ‘fetish worship of the liberty of the subject’, blaming it for unnecessarily obstructing the effort to preserve the reproductive vitality of the nation. A conventional painter as well as a physician, he was also a sort of eugenicist of art, who waged a vigorous campaign against Post-Impressionism by comparing it to the work of the ‘degenerate’ and the ‘insane’.

Trombley has done a thorough job of unearthing the relatively obscure publications of these men, and the ample excerpts he quotes are not likely to enhance their scientific reputations. How severely such views contaminated the doctors’ immediate response to Woolf herself we cannot know; even in these more enlightened times, patients often have reason to be grateful that a psychiatrist’s practice does not wholly accord with his theories. Conversely, it is at least worth observing that despite the more sympathetic views of Sir Henry Head, Woolf’s sole consultation with him in 1913 was swiftly followed by her second attempt at suicide. Concerned as he is to establish a general context for the diagnosis of Woolf’s madness, Trombley sometimes obscures the fact that only Savage seems to have had extended contact with the patient; both Hyslop and Craig (whom Leonard consulted several times on his own behalf) primarily treated Vanessa. And there is a sense in which Trombley’s lengthy dissection of their arguments, his unsparing determination to catch them out, as he often does, in self-contradiction, grants their thinking more respectful attention than it deserves. On the evidence amassed here, Woolf’s own dismissive contempt – ‘I cant conceive how anybody can be fool enough to believe in a doctor,’ she wrote to Violet Dickinson in 1904 – seems more to the point. ‘The truth is doctors know absolutely nothing,’ she said in a letter to Ethel Smyth thirty years later, ‘but as theyre paid to advise, have to oblige.’

Trombley displays little feeling for Woolf’s language. Zealous in what he takes to be her cause, he frequently ignores her own testimony and ends by producing a flat and diminished portrait of the novelist herself. Missing from his book is any recognition of the woman who could celebrate as well as dread what she did not hesitate to call ‘madness’, the diarist who could remember ‘lying in bed, mad’ and feeling ‘through it all, exquisitely happy’. The same letter to Ethel Smyth that recalls her ‘conventional’ doctors and the crippling ‘terror’ of their cures proudly lays claim to the madwoman’s visionary powers: ‘As an experience, madness is terrific I can assure you, and not to be sniffed at; and in its lava I still find most of the things I write about. It shoots out of one everything shaped, final, not in mere driblets, as sanity does.’ Such declarations may represent a kind of myth-making, an effort to assimilate past suffering by placing it in a long tradition of inspired lunacy, but these are among the crucial terms in which the woman of letters articulated her experience. It is not at all clear that Woolf would have been pleased to learn that her hallucinations made ‘perfect sense’.

Whatever the predispositions Leslie Stephen’s daughter may have inherited, there seems little doubt that particular people and events helped to precipitate her breakdowns, and that sensitive biography can serve to illuminate these proximate causes. But both Trombley and Poole are so concerned to establish Virginia as the victim of a conspiracy, to see Leonard as especially responsible for her sense of helplessness and isolation, that they fail to acknowledge the peculiar reciprocity of the Woolfs’ alliance. Shrewdly analysing Leonard’s mixed motives in marrying Virginia, his habit of consulting doctors about his wife’s case without her being there and of keeping a record of her symptoms in a secret code, Poole effectively demolished the image of the husband as rationalist saint. Yet without denying either the pain Woolf endured or the degree to which others contributed to her misery, it is still important to note that even as a ‘madwoman’ she was not always and simply a victim. If Leonard sometimes treated his wife like a helpless child, Virginia partly chose to be nursed and protected: ‘He is a perfect angel – only more to the point than most angels – He sits on the edge of the bed and considers my symptoms like a judge,’ she wrote to Vita Sackville-West in 1929. ‘He brings home huge pineapples: he moves the gramophone into my room and plays until he thinks I’m excited. In short, I should have shot myself long ago in one of these illnesses if it hadn’t been for him.’ Given Virginia Woolf’s famous declaration of her need to kill the Angel in the House, it is undoubtedly wise to view this portrait of a masculine angel with some scepticism. Yet even when one of her casually anti-semitic moods turns Leonard into a ‘poor devil’, Virginia emphasises – in a letter to Jacques Raverat – her own wilful and satisfying dependence: ‘My husband presides with considerable mastery – poor devil, I make him pay for his unfortunate mistake in being born a Jew by discharging the whole business of life. This induces in me a sense of the transitoriness of existence, and the unreality of matter, which is highly congenial and comfortable.’ Passing contempt for Leonard the Jew merges with a pleasurable contemptus mundi, as Virginia characteristically underscores the consoling uses of the relation.

Despite the well-known testimonial of her suicide note – ‘You have given me the greatest possible happiness ... I dont think two people could have been happier than we have been’ – Stephen Trombley is convinced that he knows better: ‘Neither the woman of 1913, nor the one of 1941, was happy.’ Because the suicide note seems clearly intended to relieve Leonard of guilt, because similar declarations in the letters of 1913 were written while she was restively enduring a ‘cure’ for the breakdown which followed swiftly on her marriage, Trombley concludes that her reported happiness cannot be believed. Apart from the fact that he ignores the evidence of her diary (‘Yet I daresay we’re the happiest couple in England’), and that in matters of feeling the testimony of the person in question would seem to carry particular authority, Trombley’s conclusion is based on a notably conventional idea of what human happiness requires. Though his defence of Virginia against the doctors is vaguely feminist in inspiration, his arguments make clear that he cannot credit the satisfactions of a union so obviously deficient in sex and children. That Virginia acquiesced in childlessness at Leonard’s urging and that she later often regretted the decision seems clear, even if the evidence is not quite so unequivocal as Trombley pretends (‘I should make a vile mother’). That Virginia suffered greatly from the absence of sexual passion in her marriage, that she was incapable of finding deep happiness in a union essentially intellectual and platonic, is far less clear. But Trombley is so convinced that sexual problems are the key that even Septimus Smith is said to be suffering from a guilt ‘primarily sexual’, despite the fact that his imagined sin – ‘that he did not feel’ – is most profoundly connected with his failure to mourn the Great War dead.

In Virginia Woolf’s Quarrel with Grieving Mark Spilka has recently argued that the novelist’s own inability to mourn her mother’s death was intimately linked with her first breakdown in 1895, and that the failure to grieve deeply affected the course of her subsequent mental history. The argument is persuasive, though it cancels out neither the contributions of genetic inheritance nor the anaesthesia which may have been precipitated by the sexual depredations of Gerald and George. For Trombley, however, the question of what was ‘wrong’ with Woolf can best be illuminated by a method he calls, in terms loosely drawn from Merleau-Ponty, ‘a phenomenological analysis at the level of the body: an analysis of embodiment’. The idea of Woolf’s problematic ‘embodiment’ was previously advanced by Roger Poole; as Trombley uses it here, it becomes an awkward way of talking about Woolf’s strikingly uncomfortable relation with her own flesh, a dis-ease which she granted to many of her fictional characters as well. It is also a way of insisting upon the essentially sexual nature of her difficulties, since ‘sexuality is always part and parcel of embodiment.’ But Trombley’s claim that his analysis is ‘phenomenological’, a ‘reconstruction of the other person’s experience from his own point of view’, is repeatedly belied by his refusal to credit that point of view whenever it contradicts his thesis, and by his relentless effort to probe the ‘mechanics of repression’ supposedly at work in Woolf’s texts for the real problems they are presumed to conceal. Armed with what he revealingly calls his ‘arsenal of clues’, Trombley attacks The Voyage Out until it yields up a heroine ‘totally disembodied’, signs of the trauma inflicted by the Duckworth brothers evident on every page. As a critical method, this attempt to crack the ‘code’ of Woolf’s novels produces interpretations which are heavy-handed at best, and leads to some remarkably banal observations: ‘The dominant image in this passage ... is water. It signifies fluidity, softness, comfort, and absence of hardness or resistance.’ The reductio ad absurdum of the method is the concluding interpretation of Flush, Woolf’s playful ‘biography’ of Elizabeth Barrett Browning’s spaniel, here solemnly discovered to contain a repressed autobiographical account of her flirtation with her brother-in-law, Clive Bell. Elizabeth Barrett turns out to be Vanessa, Robert Browning is revealed as Clive, and Flush is, of course, Virginia herself, the jealous third party. The extraordinary weight that Trombley places on Woolf’s guilt over this episode, which he considers one of the ‘two pivotal crises’ of her life, is perhaps connected with his own frequent attacks on Clive’s son, Quentin Bell. In the soberly moralistic spirit with which Trombley approaches both the flirtation and Flush itself, Woolf’s splendid mastery of tone, her affectionate irony and wit, utterly disappear. The coherence of this unpersuasive reading was not enhanced by his publishers, who badly scrambled the pages of the final chapter in the review copy.