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Maud Casey’s fourth novel takes us inside an asylum for women

The clinic at Salpêtrière in Paris, by André Brouillet.Wikimedia Commons

Maud Casey’s fourth novel, “City of Incurable Women,” is a haunted and haunting book, short, but densely packed with metaphor and meaning. Ghostly black-and-white photographs of the Salpêtrière Hospital in Paris and women treated for hysteria there in the 19th century, accompanied by case study notes and “photographic service” cards recording the subjects’ symptoms, convey the impression that we are reading messages from the dead past. This is an illusion created by Casey’s skillful blend of fact and fiction. The case histories and service card texts are partly based on rough translations of primary sources, partly invented. Casey gives voices to women previously seen only through their doctors’ eyes by imagining their accounts of who they were “in the before” and what they became under medical supervision. Mental illness and charged interactions between doctors and patients, previously explored in Casey’s novels “Genealogy” and “The Man Who Walked Away,” combine here for a stinging depiction of male fantasies projected onto female bodies, and of women seizing a few pitiful privileges by enacting those fantasies.

Yet the novel is poetic rather than polemic, elegantly written and filled with resonant imagery. It opens and closes with evocations of “the sounding sea, that glittering vision of the infinite,” a place of comfort and healing for these wounded women. Its narrators recall multiple doors, some opening to job opportunities (seamstress, laundress), others to foundling homes where they are abandoned as babies or bedrooms where they are raped as teenagers by their employers. The hospital is “a museum full of dead things. Anatomical drawings…skulls and spinal columns…plaster casts of our bodies. Endless photographs of us.” Or, as French neurologist Jean-Martin Charcot puts it in one of the 19th-century texts on hysteria Casey pointedly quotes in her chapter headings, “a kind of living pathological museum, the resources of which are considerable.”


Countering this view of women as resources, objects to be used and manipulated as the doctors see fit, Casey crafts individual portraits and a collective monologue that show them as human beings with histories, desires, and, yes, bodies: their principal weapon in the battle to wrest some kind of recognition from the men who rule their lives. The amphitheater in which Charcot gives his famous lecture-demonstrations is literally a theater, where patients “perform the language of our pain…making shapes that spell hysteria.” These “shapes” — bizarre, convulsive contortions of the body — are not spontaneous behaviors. The “best girls,” the ones who have the most spectacular and frequent attacks, get private rooms with clean sheets, windows that open, and “quiet to hear their thoughts.” Everyone else is dumped into the closed, crowded ward of “incurables.”

Surrealists Andre Breton and Louis Aragon no doubt believed they were being deliciously transgressive in 1928, when they celebrated “the fiftieth anniversary of hysteria” by proclaiming it “the greatest poetic discovery of the end of the nineteenth century…a supreme means of expression.” Another male fantasy, Casey slyly intimates, unless they meant the expression of what the doctors thought hysteria should look like. The doctors “teach the best girls how to make the shapes,” the collective narrator bluntly asserts. “We, the unbest girls, never learn.”


“They say those attacks were simulated,” a new doctor at the hospital remarks to Marie, a former “best girl” who now works in the Salpêtrière’s radiology lab. In this later chapter it is early in the 20th century, more than a decade after Charcot’s death. His diagnosis of hysteria has been discredited, the public demonstrations discontinued, but his reputation as a pioneering neurologist is secure. Marie, by contrast, is sneered at by a hospital intern as “one of those hysterics who has had her moment of fame.” Once stigmatized as “essentially perverse,” Charcot’s former patients are now dismissed as pathetic attention-seekers. Casey enables them to contest these slurs. “I’m not deaf,” Marie tells the intern talking about her as though she’s not there. “You cannot imagine the kind of sadness that enters the heart of a girl,” another inmate tells us, recalling a life of taxing, miserably paid labor and rejection by unloving parents; for her, the Salpêtrière is a strange sort of refuge, the only one available to her. “You are not Abandonée [abandoned girl] number 24,641,” another woman tells the daughter taken from her and placed in a foundling home. “Your name is Desirée, the desired one.”


The women of the Salpêtrière ask that we listen to them and understand that the official version of their lives is by no means the whole story. Indeed, they have their own opinions on “psychiatry, that science of the soul.” Its color is red, they tell us: “the red of longing, the red of sex and fantasy sex…the red of murder…of the desire to look and the desire to measure…the red of our blood…the red of fury.” Red is the color of both the doctor’s needs and the patients’ emotions, a dual meaning characteristic of Casey’s embrace of complexity. A visionary final chapter, “Bodies, We Are in Them,” suggests that even in the hospital, “sometimes a door swings open” and confined women can roam free in their memories, feeling at one with nature and with generations of women before them who have struggled and suffered to announce themselves as fully human beings. Despite its often somber tone, “City of Incurable Women” is in the end affirmative and inspiring, a powerful demonstration of Maud Casey’s artistry.



By Maud Casey

Bellevue Literary Press, 128 pages, $16.99

Wendy Smith is the author of “Real Life Drama: The Group Theatre and America, 1931-1940.”