In her New Yorker essay, “The Case Against the Trauma Plot,” critic Parul Sehgal describes a character whom readers are all too likely to run across in contemporary literary fiction: a figure who is “self-entranced, withholding, giving off a fragrance of unspecified damage.” As the standard plot unfolds, we come to understand that “something gnaws at her, keeps her solitary and opaque” — and then suddenly, there is a “rip in her composure and her history comes spilling out.”
Whatever comprises that destructive history determines the arc of the novel and defines the character’s entire sense of self. “Trauma trumps all other identities,” as Sehgal explains. It “evacuates personality” and “remakes it in its own image.” We readers are supposed to wonder what horrors must have already befallen the characters, just as those characters are reflecting on those events themselves. The critic bemoans the fact that the narrative moves only backwards, never forwards.
The “trauma plot” does not hold sway in scholarly nonfiction, but trauma itself is a key force in many of those texts. Social historians, for example, frequently chronicle the devastation of past events while also honoring the strength of the people who survived them. Sometimes that effort can create a dilemma: scholars of slavery in antebellum America sometimes ask if arguments about the overwhelming brutality of the system of chattel slavery undermine our ability to appreciate how enslaved people found ways to create and maintain communities, or if an emphasis on resistance and cultural continuity suggests that slavery was somehow less destructive since it did not utterly annihilate the ability of enslaved people to maintain their humanity. But fundamentally, social historians know that trauma does not lead to predetermined outcomes. Their job is at least in part to investigate whatever humans create in response to suffering and pain.
Maud Casey’s new work, City of Incurable Women, is a rigorous historical investigation and a thoughtful consideration of cultural context. Nevertheless, it is a novel. The central characters in her work are recreations, or rather animations, of female patients diagnosed as hysterics and admitted to Paris’s Salpêtrière hospital to be studied by the famed physician Jean-Martin Charcot. The author’s conception of both the asylum and its patients is based on primary documentation: medical case notes as well as glass-plate photography made at the time.
Casey thinks about trauma in ways not dissimilar to how an academic historian might: as moments of pain and suffering to which human beings respond in unpredictable and sometimes creative ways. How Casey uses this information, however, differs from what historians would do: she uses the asylum records not as evidence but as an ignition for her prodigious imagination. In her novel, these women transcend the limits of the historical record — where they are all but silent and frozen — and become main characters fully alive in their complexity.
The historical women of Salpêtrière received a psychiatric diagnosis we no longer consider legitimate: hysteria. After the patients entered the gates, the doctors inscribed dates and disorders on the women’s bodies. Sometimes the physicians suggested that the words appeared spontaneously — the disease making itself known — but sometimes they acknowledged that the labels were their own writing. Because hysteria was assumed to be the result of gendered anatomy dysfunction, the inmates were subjected to invasive treatments (including “ovarian compression”) that not infrequently veered into sexual abuse.
While Casey certainly does not erase these experiences of trauma, she uses her characters to examine how trauma and survival can be intertwined. Like the historical women, most of Casey’s characters live lives of desperation before they enter the asylum. Many were raised in poverty, orphaned or abandoned by parents, or sexually abused by employers. Opportunities for certain kinds of freedom often arise unexpectedly. The author shows how institutionalization, for example, can sometimes lift her characters out of difficult circumstances and even give them a certain kind of privilege.
The author suggests that even the diagnosis of hysteria might create its own freedom. A medical researcher from the time, quoted in the novel, notes that a patient’s body was expected to “[obey] no law other than the law of the strange and the impossible.” While such a statement about the incarcerated women might be disrespectful and othering, this novel encourages readers to question whether society’s understanding of hysteria could nevertheless allow and even encourage women to act in whatever way they chose.
And “act” is precisely what Casey suggests her characters are doing. Because 19th-century photography required time for images to form, the patient-subjects were required to hold still in poses considered appropriate for hysterics. The production of these pictures must have been a dialogic process between the research physicians and the diagnosed women. The photos, then, represent scripted behavior. Rather than assuming that these women internalized these scripts of their madness, Casey’s characters pose quite deliberately. Performing hysteria gives them a form for expression.
The ability to act well comes with external rewards for Casey’s characters. Those whose act convincingly are “the best girls,” the ones who convince others that they “are fluent in the language of their pain” — pain they express through everything from convulsions to religious ecstasy. For their performances, they are “chosen by the doctors, lifted up,” and rewarded with private lodgings and access to fresh air. For many of the inmates, lodgings like these offered a form of privacy they had not had: “a room of their own,” as Casey says in a pre-publication interview.
Incarceration within the hospital restricted the liberty of the patients, but Casey suggests that the sense of constraint and isolation had enough cracks to allow a sense of connection and appreciation to emerge. We might first assume that life at Salpêtrière was just lockdown for patients whom Dr. Charcot called “incurables … admitted for life.” But something more expansive develops, at least in Casey’s book: a community of its own, created at least partially by the women themselves. Writing in the first person plural — “we” — the author emphasizes how much the patients share experiences and identify with one another.
At other times in the novel, the story revolves around individual patients — women Casey first discovered in the archives but brings to life in the novel. One is a woman diagnosed with St. Vitus’ Dance (disordered movement thought to be a form of hysteria but now understood to be a sequela of rheumatic fever) whose story is told in the first person. When the patient enters the hospital, she finds it “filled with the stars of hysteria. It was a kind of Eden.” When she meets the other “star” patients who share her diagnosis, “it was a revelation,” an experience that allows her to appreciate the beauty and power of the women. Watching their bodies, she says, “made me love my own.”
Geneviève, another patient, finds connection based on her diagnosis both outside of the asylum and outside of time. She sees herself as a mirror of Joan of the Angels, an Ursuline nun suspected of witchcraft in the 17th-century, who had grown up in Geneviève’s hometown and had “walked the same earth.” In Casey’s novel, the hospital staff also recognize this cross-century connection. Geneviève understands “the promise [the relationship] holds in the way the doctors discuss the she who is you.” The pronoun “you” appears here because Casey writes Geneviève’s story in the second person, as if the author is addressing the character directly, creating yet another kind of communication and connection across the centuries.
Casey’s subtle braiding of suffering and strength is the beating heart of this extraordinary work of imagination. The trauma her characters experience never becomes a pat explanation for personal difficulties or failures. Instead, these “incurable women” create complex selves always in motion — full of pain but also power, pleasure, and above all mystery.
[Published by Bellevue Literary Press on February 22, 2022, 128 pages, $16.99]