Mad Travelers Book Review
Chapter-by-Chapter Summary including Supplemental Materials
The book Mad Travelers: Reflections on the Reality of Transient Mental Illnesses is about the mental illness commonly known as fugue. Fugue refers to the condition where a person will walk long distances in a dissociative state, and without a particular purpose in mind. Fugue can be classified as a particular mental disorder and was classified as a form of hysteria. In this book, it becomes apparent that fugue can present very similarly to other mental illnesses and it has frequently been conflated with multiple personality disorder. It is also strongly related to the 19th and 20th century illness of hysteria which no longer exists in this day. Many possible theories have been advanced as to why hysteria no longer exists. One of these theories is that hysteria is now diagnosed as many separate illnesses. The theory that hysteria is now diagnosed as many separate illnesses is supported by the fact that many people afflicted with fugue may now be said to be bipolar, with the fugue occuring at the beginning of a phase of mania. However, the theory that hysteria is now diagnosed as many separate illnesses is not supported by the ideas of Kuhn, specifically the inability to translate kinds from a previous paradigm into the ideology of a new paradigm (87).
The term “transient mental illness” is used in reference to mental illnesses that appear in times and places and later disappear. The term transient mental illness can be used to describe illnesses that are endemic to certain social classes or genders, or that can spread from place to place and reappear with the passage of time. This term generally refers to illnesses that are endemic to certain conditions, namely, certain times and places.
Shadow syndromes are so named because the people who posses this type of syndrome, according to a book published in 1997 regarding the subset of disorders which cause difficulties in functioning and meet some criteria for a disorder, but fail to meet all criteria for a disorder.
Thomas Cook and Son are a popular tourist group at this time. They began by hiring railway coaches to take evangelicals to temperance meetings. Later, they evolved into processing 7 million tickets for the railroad.
It seems like fugue has been an important part of society for a long time. Hence the tale of Albert, a patient diagnosed with fugue, gives us an interesting point of view on the difficulty of ascribing fugue something great and powerful. We cannot ascribe it to something great and powerful, like Michel Foucault when he says that madness is the mirror of the age of reason and an essential part of the arrangement of ideas (27).
To get to the root of the fugue epidemic, one must look at the development of fugue in America. It was first described as drapetomania or the tendency of black slaves to try to run away from their masters. Ambulatory automatism was a later diagnosis for people exhibiting fugue-like symptoms.
Interestingly, different symptoms were emphasized in France versus the United States. People exhibiting specific symptoms of fugue were viewed as being people who lost their old identity. These people would exhibit a need to travel and they would travel large distances. Interestingly, the identity could be restored by hypnosis. The diagnosis for people with these issues was Multiple Personality
The fugue epidemic lasted 22 years, according to Ian Hacking. Mark Micale is a leading proponent of theories which regard books as instrumental in creating a consensus about the diagnosis and treatment of mental illness. Furthermore, the diagnosis and treatment of mental illness, in the case of fugue, is difficult to pinpoint because the doctors diagnosing illnesses were labeling people who would be seen in France as fuguers as sufferers of multiple personality disorder.
It is important to note that Charles Davenport, a leader in the eugenics movement of the early 20th century, was working to make sure that only northern Europeans and British people immigrated to America. He engaged in this work because particular races were supposedly of purer genetic stock than Eastern and Southern Europeans. Charles Davenport, apart from being involved in the eugenics movement, ran a study sponsored by Rockefeller and Miss Harriman on fugue like states. Davenport saw the nomadic impulse as being caused by a fundamental attribute of human nature. Davenport saw this fundamental attribute as something tamed by civilization.
In Chapter 4, the author of this book, Ian Hacking, makes clear that in his opinion fugue is caused by “an ecological niche” including “medical taxonomy, cultural polarity, observability, and release” (80). Hacking argues that physicians were interested in fugue in part due to the controversy over where in the medical taxonomy it belonged. This is the medical taxonomy portion of the ecological niche of fugue. Fugue was situated between two cultural poles, one with romantic tourism which the wealthy engaged in, and the other which was only engaged in by criminal vagrants, criminal vagrancy (82), thereby creating the cultural polarity portion of the ecological niche. Hacking also argues that in order for a mental illness to be diagnosed, it must be “observable” or visible to the medical authorities diagnosing. This is the observability portion of the ecological niche. Hacking also claims that it was an inviting escape for men who were not able to travel due to family and financial reasons or due to having enough respect not to become a criminal who wanders. This escape is the release portion of the ecological niche.
In the 19th century there was substantial debate over whether fugue should be classified as a form of latent epilepsy or hysteria. Charcot was a leading neurologist in 1887. Unlike most physicians of his time, he held that male hysteria as well as the classic female hysteria could exist. The idea of male hysteria was a concept developed in large part due to Charcot’s wanting to study hysteria as a neurological disorder. Charcot was famous for being an excellent researcher and neurologist. In fact, one of his colleagues was Hughlings Jackson, a neurologist who was still famous 103 years after his publishing of a study of epileptic amnesia and fugue. Charcot held Hughlings Jackson in high regard, but Charcot was also recognized as a masterful neurologist of this time. In fact, one of Charcot’s students was Freud. One of Charcot’s claims to fame was his development of his Tuesday lectures in which he went through a case of a particular patient in front of adoring crowds. One of these patients was “Mén,” A 37 year old delivery man (35).
Charcot believed that the man’s illness was epileptic in origin because he was too old for a hysterical outbreak and had not suffered any kind of head trauma. He called Mén’s illness ambulatory automatism based on the fact that he walked automatically and didn’t show external signs of being unconscious while walking, despite the fact that most fuguers only remember their fugue with hypnosis and are essentially walking about unconsciously. Charcot did not cure Mén, but nevertheless Mén became the basis for all further epileptic diagnosis of fugue.
In light of the new distinction between the cause of fugue being epileptic or hysterical, new terminology was developed to reflect that sometimes ambulatory automatism is epileptic in nature and other times it is hysterical in nature. The hysterical fuguer was seen as hypnotically suggestible. The hysterical and epileptic fuguers were both seen to respond well to different medications, as well. The patients that fell out of the categories of hysterical and epileptic fugues were considered neurasthenic patients.
Dromomania was another term for the disorder of fugue, and became the preferred term over automatisme ambulatorie. Hysteria and epilepsy had theory behind them, but dromomania did not. Dromomania was simply a catch all term for all types of fugue, without the ideas that hysterical and epileptic fugue carried with them. Also, a new term was introduced in 1895 by Fulgence Raymond. Fulgence Raymond believed that fugue patients who were both epileptic and hysterical should be treated with hypnosis and suggestion, not chemical medicines. Fulgence Raymond also used Pierre Janet, another psychologist’s terminology and used the term psychasthenic to create a new category of fugues. The psychasthenic fugue was a type of fugue which denotes the existence of a strong urge to travel missing the traditional hallmarks of fugue. Psychasthenic fugue was a type of fugue in which the fuguer did not lose consciousness of the trip in the form of later amnesia. This type of fugue was considered a form of degeneracy, a term coined to mark the decline of France which was also used as a descriptor of the vagrancy and mental illness of fugue affected patients.
Interestingly, in Lecture 3, Titled Niches, the author of the book Mad Travelers: Reflections on the Reality of Transient Mental Illnesses, says that the word illness brings with it the idea of medical doctors. It carries with it the medical precedents of other entities titled illness. This medical precedent connotes doctors, or professionals who can help with the illness.
One later becomes aware of a debate between Ronald Simons, who argues that latah, a form of mental illness that is positioned in an ecological niche in Indonesia, is biological in nature, and Michael Kenny who argues that latah is social in nature and that any similarities upon looking at worldwide instances of this disease are coincidental in nature.
Author Ian Hacking raises serious questions as to whether latah is diagnosed based on current societal trends which overpower the public and medical consciousness. It seems like latah could be diagnosed as either fugue or hysteria, depending on the whims and confirmation bias of the doctor diagnosing the illness.
For Michel Foucault, people are products of the governmental structures that exercise power (Kelly). In no way is governmental structures producing people of certain kinds true more so than in circumstances in France during the 19th century. In a striking parallel with the current political situation in France, mentally ill patients were labeled degenerate, as France declined compared to Britain and Germany. Hacking argues that the reason why fugue was not a common descriptor in America is that there was no degenerate program in America. The categorization of mental illness was not linked to the decline of a nation as it was in France.
In 1900s America after degeneracy appeared in France, Nomadism appeared as an idea linking race and tribe to fugue like states. The appearance of nomadism heralded an era of racial division. Racial division was augmented by the fact that nomadic tendencies were considered inherited, and all inherited traits were considered to be race based.
After 1870, vagrancy was seen as part of the degeneracy movement. Beaune, a thinker at the time of the evolution of vagrancy, called the institutionalization of homeless people and the view of homelessness as a medical problem a genocide.
The meeting of psychological professionals at Nantes in August 1909 regarding mental illness in the military and fugue marked the end of French fugue.
In Chapter 4 of Mad Travelers, Hacking answers the fourth question of whether hysterical fugue was a real mental illness. It certainly exists in the diagnostic codes of today’s psychiatrists, but more so to prop up a category of dissociative disorders than because physicians are currently using the diagnosis of fugue in their everyday practice, Hacking argues. However, when we see fugue in a pragmatist light, it seems like it is not real because pragmatists define real as the object of a fact upon which all parties reach a consensus. Hacking proceeds to mention an ideal world in which genetic disorders are agreed upon by all as being a “real disorder.” In this imaginary world, if fugue proves to be a genetic disorder, it would be “real.” It seems like an inconclusive answer to say that no, fugue is not a real mental illness, because we prefer an objective reality that we can confidently say exists, rather than a reality which evolves with our language and the development of our life.
In answering the final question regarding whether analogous conclusions are to be drawn about transient mental illnesses today, Hacking calls upon his knowledge of multiple personality disorder. It is said that there was cultural polarity implied in the emergence of a great number of multiple personality cases in America in the 1970s. One of these cultural poles was child abuse, which was seen as being destructive of identity. The other of these cultural poles was a romantic challenge to identity and selfhood which is a version of German romanticism and is postmodern in nature. This cultural pole is liberation from contemporary social and political notions of the self. In the final portions of his final lecture in Mad Travelers, Hacking implies that dissociative fugue is not constructed, and even if one is to argue that dissociation lobbyists constructed the diagnosis and patients, this does not construct the ecological niche where dissociative fugue flourished. Hacking says the model of diagnosis and patients of dissociation thrived “until dissociation theorists ate their own nest, multiplying personalities beyond necessity, teaching fantasies to the innocent and escapes to the guilty” (101).
Supplemental Materials
Supplement 1, titled What Ailed Albert, begins by saying that the initial thoughts about Albert were that he was an epileptic, which later transitioned to a hysterical fuguer. Upon further reading, we find that Albert seriously injured his head upon falling out of a tree as a child. This and other somatic complaints lead us to the conclusion that Albert was suffering from some sort of brain injury.
Hacking very obviously paints a picture in Supplement one of the question of what ailed Albert being pointless because of a relationship between the patient and physician working such that patient and physician accommodate each other. This accommodation occurs much like a small child who assists his parents in covering up something although the small child knows what the truth is. In fact, Joseph Debouef described a phenomenon by which the hypnotizer and hypnotized accommodated each other like the small child and his parents. Functionally, this accomodation made both patient and physician work together during experiments and generated an influence of Tissié, the physician, over Albert, the patient where Albert dreamed of a cycling fugue and talked to imaginary companions. This is strange because Tissié, not Albert, was a cyclist, and Albert always went on fugues alone.
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