The Man Who Thought He Was Napoleon: Towards a Political History of Madness by Laure Murat (review)

Historians of psychiatry have learned a great deal in the last forty years about the nature of the great revolution in the treatment and therapy of the mentally ill inaugurated by Philippe Pinel and his successors at the turn of the nineteenth century. Pinel, at least metaphorically, freed the mad from the material and mental chains that imprisoned their bodies and minds and introduced a form of talking cure calculated to reintroduce reason into the delusional thinking of his patients. These developments were coeval with gradual administrative reforms of the asylum system that established adequate physical space, medical staffing, and (after 1838) humane commitment criteria. In this study of madness and its treatment in France between the French Revolution and the Paris Commune of 1870, Laure Murat does not refute this grand narrative, but she reveals its many limitations and, in addition, explores the political contingencies that shaped madness and its treatment in the great political and social upheavals of the century.

Murat’s aim is to recover, as far as possible, the discourse of madness itself in the case and admission records of the major Paris asylums: Saltpétrière, Bicêtre, Charenton, and St. Anne. She knows that the medical terminology of asylum doctors was the language in which the delusions of the mad were expressed, but she practices an interpretive hermeneutic in her reading that she hopes will reveal a “space” between sufferer and healer for the “translation” of these delusions. This literary technique, which she links to the political, administrative, and cultural developments of the era, provides glimpses of the ontology of madness in the turmoil of revolution.

It seems likely that the delusions and melancholia of asylum patients before 1789 concerned religion, love, and the well-being and affairs of families. Beginning in that year, and ever after, political anxieties and delusions of grandeur shaped by the events of the day made up a substantial portion of the patients’ complaints and the diagnoses made of their condition. The Terror of 1793–94 inspired visions of the guillotine and arbitrary beheading in numerous patients, and, kept alive in historical memory, appeared in case studies through the 1850s. The accession to power of Napoléon Bonaparte brought about a deluge of patients convinced they possessed absolute authority, often claiming they were the emperor himself. Diagnosed as suffering from the monomania of “excessive pride,” or delusions of grandeur, the victims of this illness dried up after the emperor’s death in 1821, only to reappear once again after the burial of Napoléon’s remains in the Invalides in 1840 and amidst the contemporary flourishing of a romantic literature of heroism, publicity, and self advertisement.

The Revolutions of 1830 and 1848 produced what many bourgeois asylum doctors were inclined to characterize as “democratic delirium,” which presumably drove the popular classes mad with unattainable notions of political equality or social utopia, affecting even women, who fell victim to these ordinarily male delusions in increasing numbers. To this point, the medical heirs of Pinel’s nosological system did not assume the political or other delusions of their patients to be direct reflections of contemporary events, but monomaniacal obsessions triggered by disordered passions and the hardships of living in crisis. However, much of the following generation of psychiatric experts directly equated politically tinged madness with participation in the radical politics of the socialist Paris Commune of 1870 and appealed to biological theories of degeneration, alcoholism, and untrammeled democracy as the cause.

Though the number of Napoléons or Queens of France under treatment at any time was not exactly indicative of events beyond asylum walls, the complaints of patients and their diagnoses varied with the times. But Murat takes pains to indicate that, particularly in political and economic crises, asylums became prisons for political enemies of the regime, refuges for the poorest...