‘Scarcely​ one year has gone by, and everything has taken on a new countenance.’ Early in the French Revolution, in 1790, Philippe Pinel observed the ‘salutary effects of the progress of liberty’ everywhere he looked. During the Ancien Régime he had seen Paris as an incubator for madness; now he recognised the epidemic of nervous illnesses that had plagued it as symptoms of a ‘social order ready to expire’. The national mind was flooded with vigour, ‘as though by some electric virtue, the system of nerves and muscles of a new life’. Everywhere in the newly energised city he heard people saying: ‘I feel better since the revolution.’

The Revolution was the making of Pinel as it was of the French medical profession, which for the first time became a significant arm of the state. He had previously been a struggling but ambitious provincial doctor with a special interest in madness: by 1793 he was physician at the Bicêtre hospital, an asylum-cum-prison on the southern outskirts of Paris long notorious for filth and neglect. He began his reforms by drawing up a list of the causes of insanity among its inmates. In striking contrast to his optimistic assessment of three years before, the longest column was headed ‘Events Connected with the Revolution’.

It was a confused and disparate category. Some of the Revolution’s casualties were enthusiasts whose initial joy had tipped into delirium. A typical case was the man who had ‘presented himself to the National Assembly as the representative of the Eternal Father, in order to relieve that assembly of its functions and to give new laws to France’. Others were its victims: men who had suffered ‘reversals of fortune’ and become deranged through fear of requisitions, state persecution and the guillotine. Many, women particularly, were no more than bystanders who had been stressed beyond endurance by events and become ‘pusillanimous and often self-tormenting’, lapsing into ‘a dark despondency of the soul alternating with terror or rage’.

Pinel, the first in the emerging profession of psychiatry to speculate on the effect of revolution on a nation’s mental health, was confronted with a paradox between revolution’s means and its ends. The national mind might have been reinvigorated, but many individuals had never recovered from ‘the profound seizures that are generally produced by various bloody and atrocious scenes’. Many more had been driven to mental collapse by the unbearable randomness with which anyone could lose livelihood, family or property. Emergency state powers, simultaneously vague and absolute, fed paranoia and fantasies of persecution. Food, fuel and medicine ran short, epidemic disease and mass starvation loomed; armies raped and pillaged, asylums were requisitioned and the mad and the sick spilled onto the streets.

For those unsympathetic to its ends the conclusion was plain: revolution was madness on a national scale. Edmund Burke, also writing in 1790, argued that the fear engendered by violent mass upheaval ‘robs the mind of all its powers of acting and reasoning’, and had surrendered the French people to an ‘incomprehensible spirit of delirium and delusion’. In 1805 Pinel’s protégé and successor at Bicêtre, Jean-Etienne Esquirol, agreed: ‘By bringing all the passions into play, by giving greater flight to feigned passions and exaggerating hateful passions … political agitation increases the number of madmen.’ Over the course of the 19th century the equation became commonplace. In 1834 Chateaubriand described the Terror of 1793-94 as ‘quite simply a mental illness’. De Tocqueville’s experience in suppressing the revolution of 1848 persuaded him that ‘in revolutions, especially democratic revolutions, madmen, not those so called by courtesy, but genuine madmen, have played a very considerable political part.’ Freud, studying under Charcot in Paris in 1885, felt haunted by the city’s ‘psychical epidemics’ and ‘historical mass convulsions’. By the end of the century psychiatrists were routinely diagnosing insurrection and insanity as cause and consequence of each other. In popular speech political fanatics became, as they remain, ‘raving’ republicans, monarchists or communists.

For others the relationship between political and mental disturbance was more nuanced. Esquirol came to believe that Pinel had been right: beneath the surface, revolution healed more often than it destroyed. In 1824, under the Bourbon Restoration, he observed that ‘the mass of people had never been so calm or less prone to excitement,’ yet there was more mental illness than there had been in 1792. The Restoration, he concluded, had inculcated a mood of ‘cold egotism’ and self-indulgence in which social ties were loosened and the old nervous symptoms of lassitude, melancholy and alienation were on the rise. Pinel’s opinion was rehearsed again after the revolutions of 1848. Bénédict-Augustin Morel, chief physician at the huge Maréville asylum in the 1850s, argued in his influential Traité des maladies mentales that ‘many neuropathies have been healed by major social agitation’, and revolution had overall ‘passed sentence on more nervous diseases than it has caused’. Political mass movements drew the melancholic and isolated out of their private suffering and into a public space that offered ‘a more vigorous direction, a more useful goal of activity, to the unhealthy, sick, indifferent constitution’.

Even if insanity increased during revolutions, it might be understood as an inevitable side-effect of progress. In his Maladies mentales of 1838 Esquirol characterised mental illness as ‘a disease of civilisation’: the fact that it was encountered more rarely in tribal cultures or under despotic rule was not an argument in their favour. The ‘new man’ hailed by Rousseau and brought into being by the Revolution had thrown off the feudal yoke and acquired rights as an individual, but this also meant new burdens of selfhood. Citizens had more freedoms than ever before, but social ties were looser; there was less constraint from family and community, but also less support. It was no coincidence that madness was most prevalent in the big cities at the leading edge of modernity, where the stresses on the self-fashioning individual were most acute. ‘A republican or representative government’, it seemed to Esquirol, might be optimal for the advancement of civilisation yet ‘more favourable to the production of insanity’.

Although the asylum records of the new clinical regime were better organised and more authoritative than any before them, their data could offer no definitive answer to these questions. They showed that admissions fell across France in 1848, then rose in 1849 and again in 1850; but did this prove the salutary effects of revolution, or indicate that medical resources had been overstretched during the crisis and normal service had resumed in its wake? ‘Events Connected with the Revolution’, as Pinel had recognised, was an untidy category that lumped together perpetrators and victims, temporary breakdowns and chronic cases: the revolutionary moment might prompt both a spike in admissions and a longer-term decline. And all such theories remained subject to the vagaries of history. From 1789 to 1871, each of France’s revolutions was to a different degree usurped and reversed: there was no way of knowing whether admission levels would have risen or fallen had they run their course.

Yet the idea that these asylum records might offer a secret key to France’s history has a long pedigree. ‘I could give the history of our revolution from the taking of the Bastille to the last appearance of Bonaparte from that of certain insane persons whose insanity connects itself with the events,’ Esquirol claimed in Maladies mentales. He never delivered on the promise, but Laure Murat takes it as the starting point for her enthralling study of the correspondences between politics and madness in 19th-century France. In drawing on patient records in the archives of the Paris asylums – Bicêtre, Salpêtrière, Sainte-Anne and Charenton – she is also taking inspiration from Pinel, whose first year at Bicêtre led him to conclude that insanity was, in her words, ‘a disease of sensitivity, whose causes were to be found in the torments of life’. A single patient’s delusions might appear meaningless, but considered en masse the patterns and themes such delusions reveal can expose the deep currents of history.

Murat believes that ‘madness has perhaps as much to teach us as dreams, to which it is secretly related.’ The summary case histories in asylum archives certainly share with dreams the tendency to be either beyond comprehension or all too obvious in meaning. When we read that in January 1818 two women were admitted separately to Charenton ‘entirely deranged’ by the price of bread and the fear that they could no longer feed their children, the connection between reality and delusion comes ready-made. At other times the ‘towards’ in her modest subtitle seems about right: descriptions of patients’ mental states are typically formulaic, reduced to a medical and bureaucratic shorthand. The records are patchy, especially at times of crisis, when they would be most revealing, but on those critical occasions when the registers are filled with cases, her method generates ‘a strange seismograph of insanity’ in which hundreds of fragments coalesce into a crowdsourced dream fugue.

If madness is a capricious guide to history, it is also a moving target. In following Esquirol’s claim through the turbulent history of 19th-century France, Murat is also tracking the institutional revolutions in French psychiatry and the constant redefinition of madness itself. This is a story that also begins in 1790, when the Assembly abolished detention by lettre de cachet: an order under the king’s seal that permitted any French subject to be detained indefinitely without trial. Under this system there was no procedure, or need, to determine whether the subject was insane, a criminal or merely a troublemaker. But from March 1790 ‘persons detained for reasons of madness’ had to have their mental condition assessed by doctors, and on the basis of the diagnosis to be hospitalised, imprisoned or released.

From this point on psychiatry became part of the state apparatus: in Esquirol’s delicate phrasing of 1822, ‘the physician enlightens the government about mental tendencies.’ The profession defined its own terms of engagement, resetting the boundaries between lunatic and criminal, asylum and prison, political ideology and insanity. The asylum population mushroomed over the century: at its beginning there were around five thousand patients in state institutions, by its end more than fifty thousand. This makes it hard to judge from psychiatric records alone whether madness was genuinely surging to epidemic levels or merely being redefined. It also frustrates any direct attempt to read the causes of madness through politics, since levels of insanity increased steadily through revolutions, counter-revolutions, republics and monarchies alike. Murat’s seismograph of insanity holds out the promise of a view that escapes the medical frame by incorporating, if not the authentic voices of the mad, at least ‘the joint murmur of patient and doctor’.

The signature delusion of Pinel’s patients in his early days at the Bicêtre was the fear of losing one’s head. Pinel himself had been drafted, much against his will, into the cortège that escorted Louis XVI’s tumbril on 21 January 1793 from the Temple prison to the guillotine in what is now the place de la Concorde, and had witnessed the regicide ‘in a stupor of profound consternation’. In the following months he encountered many prisoners and lunatics whose terror of the guillotine had become chronic: a ‘habitual consternation that led to wasting away and death’.

But the guillotine was also part of the cures that made Pinel’s reputation. The guilt-ridden tailor, a famous case recounted in his Traité of 1801, was tormented by the fear that someone had heard him carelessly voicing his disapproval of the king’s execution and had reported him to the Committee of Public Safety. When Pinel encountered him in Bicêtre he was hunched, mute and frozen, permanently waiting for the guillotine to fall. Pinel set him to mending his fellow patients’ clothes and then devised a coup de théâtre: three of his medical students processed to the tailor’s cell and held a mock session of the Committee in which he was acquitted of treason. His symptoms promptly disappeared, though the cure proved only temporary. Another celebrated case was that of the clockmaker, convinced that he had already been guillotined. Somehow the verdict had been reversed, but his head had become confused with others in the basket and he had been given back someone else’s. Again, Pinel staged an intervention, this time by a fellow patient who cheerfully pointed out the absurdity of his delusion. The clockmaker ‘retired confused amid the peals of laughter all around him and never again spoke of his change of head’.

Pinel’s revolutionary therapies combined a gentle and sympathetic attention (douceur) with what he called a ‘formidable show of terror’: commanding instructions backed up by the knowledge that any disobedience would be met with a team of restraining nurses and a warning that the ‘only choice is to submit’. It was a strategy that echoed the rationale of surgery, and also that of Terror in the Revolution: a burst of violence in the interests of future wellbeing. The same combination characterised the emerging psychiatric profession as a whole.

The two faces of Pinel’s therapy were mirrored in the administration of the new-model asylums, where the role of doctor was supplemented by that of a superintendent responsible for discipline: as Pinel described it, ‘keeping order among the staff, exercising correct restraint over turbulent and very agitated patients, and determining whether a patient is suitable for the interview requested by one of his friends or close relatives’. But the distinction was hard to maintain. By 1793 public hospitals, and often private nursing homes, were being requisitioned as prisons, and doctors becoming de facto jailers. The separate categories of political prisoner and lunatic established by the abolition of lettres de cachet were blurred by the demands of revolutionary justice. Enemies of the state were confined as lunatics; equally, those awaiting the guillotine for political crimes could be saved by pleading insanity.

Pinel later claimed that he had saved several obviously fake lunatics from execution. But he was also expanding the definition of madness. He classified the persistently devout as melancholics suffering from ‘delirium or holy intoxication’, a diagnosis that supported the closure of monasteries and the abolition of religious vows in 1790. In later phases of the Revolution, atheism was similarly pathologised. The Marquis de Sade, the most notorious case, was described by the prefect of police in 1803 as ‘in a perpetual state of libertine dementia’, although Sade’s physician at Charenton, Antoine-Athanase Royer-Collard, disputed the diagnosis. ‘This man is not insane,’ he replied. ‘His rage is for vice, and it is not in a home devoted to the medical treatment of insanity that this particular frenzy can be curbed.’ Sade was a highly visible nuisance, and to the devoutly Christian Royer-Collard an abomination; the question of whether he was a madman, a criminal or a traitor was moot, just as it had been under the Ancien Régime.

Morbid terror​ of the guillotine was occasionally recorded in Bicêtre until the 1850s, but by that time it had been usurped by the most celebrated delusion of them all. On 15 December 1840 the remains of Napoleon Bonaparte, rumoured to be miraculously uncorrupted, were taken to the Invalides accompanied by vast crowds and laid to rest in a grandiose imperial ceremony. That same year, Bicêtre admitted at least a dozen Napoleons to its wards.

‘Delusions of grandeur’, of which believing oneself to be Napoleon became the archetype, rose to extraordinary medical and cultural prominence during the July Monarchy. By 1840 it accounted for a quarter of all diagnoses of insanity. It was a form of monomania, the term coined by Esquirol to describe an uncontrolled delusion or obsession (idée fixe) in one who might otherwise appear sane. He conceived it as a disease of the passions, a consequence of ‘self-love, vanity, pride and ambition’, and hence a moral failing as much as a pathology. Mad Napoleons were always irascible and imperious, reciting their interminable compositions, brooking no argument and demanding that everyone submit to their will. Doctors told tales of miraculous cures effected in the Pinelian manner by humouring them, but their blind rages were more commonly addressed with beatings, straitjackets, cold showers and solitary confinement.

During the 1830s monomania became a term of everyday speech, and delusions of grandeur inseparable from the Romantic spirit of the age. The return of Napoleon’s remains catalysed a sense that the era of heroism had passed, the passions of political struggle replaced by bourgeois dullness. Blockbuster novels traded in impossibly heroic narratives, their protagonists adopting grandiose false identities and concealing fateful secrets; Balzac claimed that what Napoleon ‘did with the sword, I will accomplish with the pen’. Characters embarked on fantastic quests that inevitably recalled Don Quixote, whom Esquirol had cited as the perfect example of the monomaniac. For some psychiatrists, ‘the impact of modern novels’ was itself becoming one of the leading causes of madness.

Napoleon – who declared during his final years on St Helena that ‘my life is a novel!’ – was the figure in whom reality and fantasy were conjoined. He was the apotheosis of Rousseau’s new man, who had transcended the limits of history and taken his place among the immortals. Unlike any sovereign before or since he was entirely self-made, and thus uniquely compelling to the delusional. A pretender to the monarchy would always remain just that, but a fake Napoleon might through supreme effort of will become the real thing.

Murat’s records of the mad Napoleons are thin, perhaps due to the exasperation of their physicians: ‘He soon informed us that he was the emperor of France, with millions in riches, that Louis-Philippe was his chancellor etc.’ Their monomania was experienced by others as a tedious performance within which the subject had trapped himself (it was always a him). It is appropriate that their inner world is most convincingly drawn in a novel, Simon Leys’s delicately ambivalent The Death of Napoleon. The most penetrating mad testimony falls outside Murat’s remit, since its subject ended up in a British rather than a French asylum. James Tilly Matthews – my book The Influencing Machine is about him – belongs in Pinel’s original cohort of those driven mad by the Terror of 1793, which he spent under house arrest in Paris as a suspected double agent. Confined later in Bedlam, Matthews would surpass Napoleon by styling himself ‘Omni Imperious Arch-Grand-Arch-Emperor Supreme’, and writing long proclamations itemising the bounties offered to all the nations of the world for the ‘infamous usurping murderers’ who had conspired against him. In other phases of his derangement he believed himself under the mesmeric influence of Jacobin agents: ‘We told you that you were Buonaparte’s talisman,’ they mocked, ‘and that we would work him up to as high a pitch of grandeur as we would fix you degraded below the common level of human nature.’ Napoleon had become the new measure of man, and in the process consigned his enemies to subhuman depths.

Napoleon had taken an interest in the question of madness, and there are apocryphal accounts of his exchanges on the subject with Pinel, who from 1805 was one of his consulting physicians. He is said to have inquired on his return from Elba whether there were now a greater number of madmen; Pinel replied no, but thought to himself ‘that great geniuses, and famous and ambitious conquerors, were perhaps not free from a touch of madness’. In another version of the story Napoleon winked: ‘I must take care not to fall into your hands.’ But after 1840 his legacy was coloured by the monomania diagnosis. His alleged hallucinations – for example, the moment in 1806 when he insisted he could see his ‘lucky star’ hanging in the air above him like Macbeth’s dagger – were seized on as evidence of insanity. Many suggested that he had tipped over into madness in 1812 or during his final exile. Others theorised a dual personality: Bonaparte, the ruthlessly sane general of 1796, locked in struggle with Napoleon, the mad emperor whose delusions of grandeur had engulfed Europe in flames. Cesare Lombroso, in Genius and Madness of 1864, had no hesitation in diagnosing ‘a case of psychic epilepsy with its gigantic megalomaniacal illusions, its impulses, and complete absence of moral sense’.

Lombroso’s ‘psychic epilepsy’, which he held to be the key to immorality, criminality and genius alike, was indicative of an expanding taxonomy of madness in which political activism became a symptom. The groundwork had been laid by Esquirol in his 1820 essay on the revolutionary Théroigne de Méricourt, which cast her as the classic case study of ‘lypemania’ or melancholy. Théroigne had been a celebrated figure in the early days of the Revolution, leading a spirited emancipatory campaign to allow women to enlist in the army. In 1794 she had been declared insane to spare her from the guillotine; thereafter she lapsed into depression and came under Esquirol’s care. His essay presented her as a bloodstained harpy, driven to insanity by her fanatic lust – ‘a red bonnet upon her head, a sword by her side, and a pike in her hand, commanding an army of women’ – but Murat contrasts this portrait with its sources, in which Théroigne appears as a vagabond, fleeing a brutalised childhood and finding her métier in the political debating clubs. When she fell from favour with the mob, it was for her adherence to the moderate Girondin faction in the Convention. For Murat she is indeed ‘a textbook case’, but of an unhappy end being used to construct the ‘ravages supposedly caused by revolutionary ideals’.

After 1848 psychiatrists routinely asserted that political activism stirred up female nervous maladies and exposed hereditary weaknesses, and that the nation’s mental health had been weakened by the expansion of the democratic franchise. The new diagnosis of morbus democraticus recast the spread of communist ideas as an epidemic of insanity. ‘Communist monomaniacs’, in the view of the conservative psychiatrist Alexandre Brierre de Boismont, ‘tear down all artificial separations and arbitrary distinctions’, replacing the real world with a delusory utopia of ‘brotherhood’. Others believed that communism pointed towards a cure for the ills of bourgeois individualism. Jacques Bouchet, following Esquirol, argued that monomania was ‘merely the result of the principle of individualism taken to an extreme’; the remedy was ‘the opposite system, that is to say the renunciation of self’, after which ‘a communist feeling steadily seeps into thoughts and acts, putting a halt to individualist impulses and the deviations they cause’.

The faultline between these views was expressed in the language of politics, but it also reflected the gulf between public and private medicine. Bouchet was the director of the public asylum at Nantes while Brierre de Boismont ran a private nursing home with a wealthy clientele, for whom ‘events connected with the Revolution’ had a quite different complexion. During the Second Empire these social divisions sharpened. More people were incarcerated for petty crime and begging, and the registers of public asylums filled with a litany of persecution complexes and the compensatory delusions of the wretched: patients believing themselves entitled to thrones, vast fortunes or high government office. Some of these had a political cast: Murat unearths the record of a butcher who believed that France had become a free republic where ‘everyone can have and carry off what they can take,’ and a labourer who announced he was ‘summoned to rule the world, to obtain bread at low cost’. But the view presented by these asylum records is an epidemic not of morbus democraticus but desperate privation.

With​ the Prussian invasion of Paris in 1870 and the Commune of 1871, the two halves of Second Empire society were violently sundered. The experiences of those at the barricades recalled 1793 and 1848, but this time accompanied by sustained artillery bombardment that produced the terrifying symptoms later known as shellshock. Some asylums closed, emptying their patients into the carnage, but Sainte-Anne continued to record diagnoses of insanity up to and including the ‘bloody week’ of suppression from 21 to 28 May 1871. Its records provide Murat with a climax of hallucinatory clarity and intensity. Men became battle-crazed and frenzied, while women were swallowed up by the capacious diagnosis of melancholia: a large number believed themselves to be Joan of Arc, whose canonisation campaign had been launched the previous year. Men were haunted in particular by visions of wild animals, suggesting the psychological toll of a diet that progressed from horses to dogs, cats and sparrows and finally to the attractions at the zoo: monkeys, lions and elephants.

In the aftermath the Communards were portrayed in the press as a demented rabble of alcoholics and pyromaniacs, and their insurrection as mass insanity. But the city’s repeated relapses into revolutionary mania also prompted deeper probings. Why was France condemned to repeat these nightmare scenes while Britain or Germany – where socialist ideology, or pathology, after all originated – were capable of gradual reform? The German physician Carl Stark suggested that the French had ‘a brain organised in a special fashion’: ‘the weight of French brains,’ he claimed, ‘is less than that of German brains; and, strangely, the brains of French horses are also lighter than those of German horses’. Brierre de Boismont believed that the Communards were the latest incarnation of an incorrigible underclass whose condition was as much moral as medical. He proposed a new penal system in which the distinction between asylum and political prison was erased.

By 1871 the sentiment that Pinel had heard so often in 1790 – ‘I feel better since the Revolution’ – had become vanishingly rare. Murat locates its bloody-minded survival in the memoir of Jules Vallès, founder of the insurgent journal Le Cri du peuple, writing in 1881 about the fate of his artist friend André Gill, who ended his life confined in Sainte-Anne and Charenton. Gill broke down after seeing his painting of a madman, Le Fou, badly hung at the Salon, but Vallès attributed his melancholy end to his refusal to join the barricades. ‘You have to take sides. Gill did not want to. He shunned every partisan cap and simply donned an artist’s beret.’ At the end of a century in which madness and politics had been proposed as cause, symptom and cure of each other in every possible combination, Vallès nominated himself as the anti-Théroigne, whom revolution had not destroyed but rescued. It was, for him, simply ‘how not to go mad’.