What was wrong with Alice James?
LET’S START WITH WHY ALICE COULDN’T WALK.
A year ago a friend of mine developed a condition with the somewhat Victorian-sounding name of Benign Paroxysmal Positional Vertigo (BPPV), a benign and ultimately self-correcting inner ear condition. Suddenly, she literally could not sit up or raise her head from the horizontal without being hit with waves of nausea and vertigo. It was like being seasick on dry land. This struck a chord and I wondered if BPPV might explain what happened to Alice James on her voyage to England in 1885, unraveling the mystery of her baffling inability to walk (when, just days before, she walked perfectly well).
Even today, when the mechanism is understood and exercises have been devised to correct it, BPPV can last for weeks or months. (After doing the exercises, my friend’s vertigo disappeared after four weeks.) In 1885, it might have lasted forever. If Alice stopped walking long enough, her muscles would atrophy—and her brothers’ descriptions of her “pitiful, shriveled” legs suggest this was the case—and she would be bedridden for the rest of her life. As Alice was.
THE INNER EAR OF WILLIAM JAMES
The sense of balance and equilibrium is primarily controlled by a maze-like structure in the inner ear called the labyrinth, at one end of which sit the semicircular canals. These fluid-filled loops allow the brain to read our position in space. One of the first physicians (if not the first) to describe the role of the semicircular canals was William James. It would be fair to say he was obsessed, writing two articles on the subject for the New England Journal of Medicine. When his sister and Katherine and Louisa Loring sailed to England in 1885, William saw them off with a special going-away present: “blistering patches” to wear behind their ears to prevent seasickness.
Katherine used the patches and did not get seasick. Alice very likely did not (she had a skeptical attitude toward the fads her brother took up), and was massively seasick. By the time she reached Liverpool she could not walk at all. We don’t know about Louisa.
William James understood that the ear’s semicircular canals played a vital role in providing feedback about one’s position in space and that a disturbance of this part of the vestibular system could play a role in seasickness. In letters to friends about to sail to Europe he’d discourse at length about these canals and the calcium carbonate grains floating in gel that act like a carpenter’s level to inform the brain which way is up. He was fascinated in part because he was a martyr to seasickness.
Thus perhaps part of Alice’s bedridden condition might be explained. But what about the rest?
WHAT WAS “GOING OFF” ALL ABOUT?
Since adolescence at least, Alice James had been “going off,” i.e., suffering spells of fainting or loss of consciousness. A remark of Katherine’s (reported in Alice’s journal) tells us that during her years in England Alice “went off” every day before noon. There are sometimes hints of “fits,” and her episodes of “going off” were often linked to the hyperemotional states to which she was susceptible and which any jarring piece of news could set off.
In Alice’s day there were no X-rays and few blood tests; the endocrine system, like the brain, was terra incognita; microorganisms were not known to cause infectious diseases. Antibiotics lay in the distant future. Diseases were believed to result primarily from aspects of climate—bad airs and such—and could be remedied by a spell in a better climate and/or a spa with beneficial waters. Before drug and food safety laws, doctors dispensed medicines that were useless at best and often harmful, containing arsenic, mercury, or other toxins. (Small wonder that Alice’s medicines always made her worse.) Add to that the damage done by tight corsets and by common toxic household products, such as paint or wallpaper containing arsenic.
In short, there is no way to arrive at a definitive diagnosis for Alice, who suffered from blinding headaches, “rheumatic” pains in all her joints, perpetual cold, as well as inability to walk. If she suffered from hypothyroidism, to take but one example, no one would have been the wiser, and her extreme fatigue and other symptoms would have been ascribed to weak nerves. That said . . .
THE SNAKES IN HER BELLY
Let’s take a closer look at what was for Alice herself her most troubling symptom, a churning sensation in her stomach area (“like snakes coiling and uncoiling”). It afflicted her just as she was falling asleep and was associated with overwhelming anxiety and/or panic.
The worst kind of melancholy is that which takes the form of panic fear, William James observed in “The Sick Soul” chapter of The Varieties of Religious Experience (1902), and then went on to quote a first-hand account by an unnamed Frenchman, which he claimed to have translated.
I went one evening into a dressing room in the twilight to procure some article there; when suddenly there fell upon me without any warning, just as if it came out of the darkness, a horrible fear of my own existence. Simultaneously, there arose in my mind the image of an epileptic patient whom I had seen in the asylum, a black-haired youth with greenish skin, entirely idiotic, who used to sit all day on one of the . . . shelves against the wall, with his knees drawn up against his chin, and the coarse grey undershirt . . . drawn over them inclosing his entire figure. He sat there a kind of sculptured Egyptian cat or Peruvian mummy, moving nothing but his black eyes and looking absolutely non-human. . . . That shape am I, I felt, potentially. Nothing that I possess can defend me against such a fate, if the hour for it should strike for me as it struck for him. . . . I became a mass of quivering fear. . . I awoke morning after morning with a horrible dread at the pit of my stomach, and with a sense of the insecurity of life that I never knew before . . . this experience has made me sympathetic with the morbid feelings of others ever since.
. . . I remember wondering how other people could live. . . . My mother in particular, a very cheerful person, seemed to me a perfect paradox in her unconsciousness of danger. . . . I have always thought that this experience of melancholia of mine had a religious bearing.
After William’s death, his eldest son, Henry James III, told a biographer that his father had written the passage; there had been no Frenchman. (For James connoisseurs, the word potentially is a clue; William used the term—not then in wide circulation—so frequently that Clover Adams joked about it in letters.) And the mother of the “Frenchman” clearly bears a marked resemblance to Mary James, as her children viewed her.
For William, as for his father, the religious sense was awakened by a searing experience of panic-fear, and the “Frenchman” passage in The Varieties carries a footnote: “For another case of fear equally sudden, see Henry James: Society, the Redeemed Form of Man, Boston 1879, pp. 43 ff.”
This, of course, was on account of Henry James Senior’s Vastation, which occurred in 1844. Sitting one evening at the family dinner table after the meal, gazing at the fire, he experienced
a perfectly insane and abject terror, without ostensible cause, and only to be accounted for, to my perplexed imagination, by some damned shape squatting invisible to me within the precincts of the room, and raying out from his fetid personality influences fatal to life.
With this footnote, William implicitly (and privately) acknowledged the kinship between his father’s horror of some damned shape and his own of the green-skinned epileptic boy. Alice’s “snakes,” coiling and uncoiling in her stomach since childhood, were equally horrifying for her and arose most likely from the same familial weakness. She who lost consciousness daily and suffered severe pain with little complaint was utterly undone by this white-knuckled, pure-adrenaline fear centered in her gut. Only at the very end of her life was her panic dispelled by Dr. Tuckey’s “moonbeam radiance” and his hypnotism.
Toward the end of his life, Henry James Jr., too, was completely derailed by a panic so desperate it prompted him to submit to a crude form of psychoanalysis at the hands of family friend James Jackson Putnam, M.D., who had become a Freudian. (Who wouldn’t like to be a fly on that wall?)
Whatever their other illnesses, many of the Jameses clearly suffered from panic disorder, the anguish of which can be inferred from the fact that ten percent of its victims commit suicide. If left untreated, panic disorder almost inevitably leads to agoraphobia. Even if she had not lost the use of her legs, Alice might have become a shut-in.
But that is not all that lurked in the James “blood.”
Henry James Senior had several peculiar and/or mad relatives, including his niece, Kitty James (Prince), who ended her life in the Somerville asylum (the precursor to McLean Hospital). In her own letters and those of her relatives, Kitty appears to be a textbook case of severe bipolar disorder. So was Alice’s fourth brother, Robertson (Bob) James, who was in and out of sanitariums and whose terrible mood swings and alcoholic rages alienated his extended family and wrecked his marriage. Henry James Senior may well have been bipolar as well (which might explain why he took so many mysterious trips and why Aunt Kate saw fit to burn the family letters after his death) but the evidence we have is inconclusive. He was undeniably an unusually emotional and tempestuous man.
Then there is William James, whose life is minutely documented. His diaries and letters and the letters of those close to him paint a picture of recurring cycles of mania (sleeplessness, flights of ideas, et cetera) alternating with intractable melancholia, which nearly drove him to suicide several times. His struggles made him exquisitely sympathetic to the suffering of others, and, throughout his life, he went out of his way, professionally and personally, to befriend troubled souls and seek a cure for mental illness.
Was Alice bipolar? Possibly, but her diary and letters, while highly original and definitely Jamesian, do not necessarily (in my admittedly unprofessional opinion) strike a manic note. The fact is, we just don’t know. Our task of diagnosing people beyond the grave is complicated by the fact that late nineteenth-century psychiatry did not recognize our diagnostic categories. Melancholia, mania, and what was called “cyclical mania” were described in Alice’s lifetime, but schizophrenia was unknown. Schizophrenics were herded into the catch-all category of Hysteria, which embraced everything from florid hallucinations, hysterical blindness and paralysis, dissociative and fugue states, to vague female discontents. At various times Alice’s doctors diagnosed her with hysteria, neurasthenia (an equally vague term meaning “weakness of the nerves”), “suppressed gout” (a disease unknown to modern medicine), “nervous hyperaesthesia” (presumably, extreme sensitivity or nervousness) and, implicitly, with not being a proper female.
The late nineteenth century was very keen on nerves. In the most advanced medical centers, patients with “nervous” complaints—i.e., just about everybody—were hooked up to batteries and soothed with gentle currents. Dr. James Jackson Putnam, William James’s good friend and former lab partner, held the prestigious post of Electrician at Massachusetts General Hospital, and often treated William and kept him supplied with batteries, which William carried to Europe when he traveled, electrifying himself diligently. Alice appears to have been less than enthusiastic. Like everything else, electricity seemed to make her worse.
Whatever ailed her, Alice James herself did not consider her life tragic or wasted, as she explained to William in a letter not long before her death:
Notwithstanding the poverty of my outside experience, I have always had a significance for myself—every chance to stumble along my straight and narrow little path, and to worship at the feet of my Deity, and what more can a human soul hope for?