The cartelle cliniche were introduced in the 1820s (so I have anticipated them in this book) and gradually became more and more prescriptive, so that by filling them out the doctors ended up with a diagnosis. It was probably better for the patients in earlier days when the doctor-priests started with a blank sheet of paper and an open mind.
The admission book was as I describe, kindly shown to me by Professor Luigi Armiato when I first visited the archives of San Servolo for research in 2007. Also the documents of admission, with their logo of the Regno d’Italia, are as seen by Marcella.
The idea of isolating lunatics for their own good is a longstanding one. At the time this book is set, Venice herself might have been described as mentally unstable. She had in a dozen years been a Republic, a Municipalità Provisoria, French, Austrian, French again, and now she was a feather in the hat of the inglorious Regno d’Italia. So, I suspect, it was all the more important to keep any individuals with visible mental fissures from presenting themselves as metaphors for the city’s cracked and limping existence. The police were ordered, by each successive authority, to be vigilant for such elements and to hustle them speedily across the lagoon and out of sight.
Many of the people confined at San Servolo suffered from physical illnesses that threw up symptoms of mental disorientation – pellagra, scurvy and rickets, all of which were endemic among the poor underfed classes. A wholesome diet at the island soon cured them.
The practice of isolation remained prevalent through the nineteenth and twentieth centuries. It was only in the last quarter of the twentieth century that it became fashionable, or perhaps expedient, to release the patients of mental asylums ‘into the community’. This occurred in Italy in 1978 and in the United Kingdom in the 1980s.
William P. Letchworth, in The Insane in Foreign Countries (1889), wrote: ‘In Ireland, there was Glen-na-galt, or the “Valley of the Lunatics”, beautifully situated in County Kerry, not far from Tralee. To this vale it was believed that every lunatic would eventually gravitate if left to himself. The process of cure consisted in drinking the cooling waters and eating the cresses that grew beside the spring.’
Cold-water cures were also identified in the same source: ‘It is recorded, that, not many years since, lunatics were denuded and thrice dipped at midnight in Lochmanur, in the far north of Scotland.’
Philippe Pinel (1745–1826) is regarded as the father of modern treatment for the insane. He was the first to institute a relatively humane regime at the infamous Bicêtre and La Salpêtrière hospitals in Paris. Under his care, patients suffering from what was then diagnosed as nymphomania were not shackled, purged or bled as a matter of course. Pinel also made a practice of talking to them about their problems.
George Man Burrows, in his 1828 work Commentaries on the Causes, Forms, Symptoms, and Treatment, Moral and Medical, of Insanity, observed that all lunatics had a ‘peculiar odour’. He said, ‘It has been compared to the scent of henbane in a state of fermentation; but I know nothing which it resembles . . . I consider it a pathognomonic symptom so unerring, that if I detected it in any person, I should not hesitate to pronounce him insane, even though I had no other proof of it.’
Burrows was among those that claimed that hysteria (aggravations of the womb) could manifest in excessive saliva, tears and urine. ‘Affusion of cold water’ was one of his recommended cures.
Jean-Étienne Esquirol (1772–1840), Pinel’s student and successor, noted bad breath among his patients at La Salpêtrière, but this might have had something to do with rampant scurvy there due to the poor diet: the disease causes rotting of the gums.
In Practical Remarks on Insanity (1811), Bryan Crowther urged close supervision of the excretory functions of all lunatics, who were inclined to withhold bowel movements and urine. Applying leeches to the pubis was suggested by John Millar, in his essay on amenorrhoea, ‘Hints on Insanity’ (1861).
The custom of putting inconvenient women in mental asylums has been observed in fact and fiction before. William P. Letchworth, in his aforementioned work, noted, ‘A grave abuse connected with these receptacles for the insane lay in the fact that they were resorted to by the powerful and unscrupulous as conveniences for getting rid of any relative who might happen to stand in the way of their selfish aims.’
The notion that certain physiological traits predisposed women to immorality was championed by the nineteenth-century Italian psychiatrist Cesare Lombroso. His ideas were similar to those cited by Minguillo, although he is of a later epoch.
The chain device that Minguillo designs for Marcella is based on the equipment used to confine an unfortunate prisoner known as James Norris at Bethlem Royal Hospital, London, for fourteen years.
My descriptions of the postures of the mad were partly inspired by Raymond Depardon’s moving black-and-white photographs of the inmates of San Clemente towards the end of the last century.
Santa Catalina (St Catherine of Siena)
Catalina Benincasa was born in 1347, the twenty-third child of a family that lived near the Dominican church in Siena. She became a nun in 1363. She never learned to read or write but dictated a visionary work known as The Dialogue to her followers. She crusaded to bring Pope Gregory XI back from Avignon to Rome.
Sor Loreta’s account of Santa Catalina conforms to the hagiographies written in or close to the saint’s time. Catalina threw herself into a boiling spa in order to disfigure her face and body and thereby discourage future suitors. She deprived herself of sleep and ate almost nothing, sometimes sucking the juice from vegetables before spitting out the pulp. One witness described her pushing twigs down her throat to help her vomit up food.
Fasting appeared to lessen her need for sleep. She poured her energy into great feats of housework, rather like Sor Loreta’s cleaning of the convent. Despite her own eating ‘infirmity’, as she herself described it, she performed feeding miracles for the destitute and also fed them with charity. She drank the pus of a diseased tertiary, describing it as exquisite. Yet the odour of her own body and of her clothes was always described as remarkably sweet. Santa Catalina claimed to have received the stigmata, though no one saw the marks until after her death. At times she would drink only the blood of Christ, in other words, the Eucharist wine. She also had visions in which she was encouraged by Christ to suckle on the wound in his side.
In 1366 she had a vision of a mystical marriage to Christ, in which he offered her a wedding ring made of his circumcised foreskin. Santa Catalina’s marriage is depicted in paintings by Michelino da Besozzo (at the Pinacoteca in Siena), Barna da Siena (Museum of Fine Arts, Boston), Giovanni di Paolo (Metropolitan Museum, New York), several by Lorenzo Lotto (Galleria Nazionale d’Arte Antica, Rome, and the Alte Pinakothek, Munich) and Filippino Lippi (San Domenico, Bologna), among others. Some show Catalina marrying a baby Jesus; in others her bridegroom is adult. Saint Catherine of Alexandria also had a mystical wedding with Christ, often shown in art.
Santa Catalina died at the age of thirty-three, after a fast in which she gave up even water.
Santa Rosa of Lima
Isabel De Flores y Del Oliva was born in Lima, Peru on April 20th 1586, and died there on August 30th 1617. It is thought that Rosa modelled herself on Santa Catalina of Siena. She was beatified by Clement IX in 1668, and canonized in 1671 by Clement X, the first saint of the New World. She is the patron saint of Lima and Peru, and also of the Philippines, India, florists, gardeners and people ridiculed for their piety. She is often depicted with a wreath of roses around her head and keeping company with the Christ Child. One account of Santa Rosa records how when she gazed adoringly at a portrait of Christ, the painting began to sweat.
Fasting and fast-tracking to sainthood
If Sor Loreta had lived in the sixteenth century or earlier she might have actually succeeded in getting herself beatified.
Some mediaeval Catholics believed that it was Adam and Eve’s sensual gluttony, in eating the forbidden apple, that had humankind exiled from P
aradise. Therefore to refrain from food was to ‘feed’ Christ, who had fed mankind by literally sacrificing his body for its redemption. Some female saints, including Catalina of Siena, believed that by suffering bodily torment like Christ’s they would be able to save souls, just as he had.
Central to Christian ritual is the concept that Christ literally fed his followers directly from his body. Partaking of Christ’s sacrifice is symbolized in the consumption of the wine and wafer, his body and blood, at the Eucharist.
In Venice, Quirizio da Murano (fl. late fifteenth century) painted Christ offering a Eucharistic wafer and also opening his robe to show the wound at his breast to an eager praying woman, as if inviting her to suckle. Other paintings show Christ projecting the blood from his wound directly into a communion chalice.
In mediaeval times, a woman was not permitted even to touch the Host, yet the visions of many female saints portrayed them grasping it. Several saints, ‘purified’ to a state of heightened perception through starvation, claimed to be able to distinguish a false Host from a real one, as Sor Loreta does. Benvenuta Bojani claimed that she received her only food from an angel who dispensed it with his own fingers from a luminous vase.
Through such audacious visions, women created an opportunity to dictate or write religious tracts, positioning themselves somewhere between God and humanity, acting as his primary messenger. This was a role denied to most women by the patriarchal church up until very modern times. It is still denied in some places.
Fasting women also took themselves beyond the authority of their families, their sister-superiors in the convent and male doctors by establishing that their relationship was directly with God. Claiming special honour in his sight, they felt empowered to overrule any human intermediary.
The female saints mentioned by Sor Loreta, and their painful food-oriented penances, are all as recorded in various hagiographies. In the early modern period, one of the main ways women could ‘prove’ an advanced spirituality was by demonstrating a supernatural amount of control over their own bodies, manifested in starvation, hyperactivity and flagellation. The cruelties these women practised on themselves from childhood or puberty more or less guaranteed that they would have short lives of constant pain: headaches, stomach aches, boils and difficulty in breathing. Mental disorientation and hallucinations were also likely symptoms.
Some female saints adulterated the food that they did consume with ashes or gall to ensure no sensual enjoyment. Some, like Angela of Foligno and Catalina of Siena, ate filth and pus, which they claimed tasted sweet to them. Angela tried even to eat the putrefied flesh of a leper that came away in the water when she was washing him (but choked it out). Caterina of Genoa boasted of eating lice as big as pearls. Several, including Teresa of Avila, deliberately induced vomiting. Perhaps the most extreme was Veronica Giuliani, who fasted assiduously. But if a plate of food arrived at her place in the refectory mysteriously spattered with cat vomit or adulterated with rodent parts or containing a whole leech – then Veronica would fall on it voraciously. On the orders of an abusive confessor, she also licked the spider webs and spiders off the walls of her cell.
In her magisterial work Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women (1987), Catherine Bynum explains food’s central role in both life and religious observance. Yet it was exclusively the women who devoted a great deal of their time to preparing or dealing with food. Even rich women at least supervised the production of food in the home. If they fell pregnant, they literally became food for the babies growing inside them. After giving birth, they fed babies from their breasts.
If food was women’s kingdom, sometimes it was also the only part of their lives over which they exercised authority. As Bynum points out, ‘human beings can renounce, or deny themselves, only that which they control . . . It was far more difficult to flee one’s family, to deny a father’s plans for one’s betrothal, or to refuse sexual relations to a husband than it was to stop eating.’
The onset of fasting was generally at puberty (though some, like Veronica Giuliani apparently, refused their mothers’ breasts on fast days even, in infancy). In mediaeval times, twelve or thirteen was the age when families began arranging husbands for their daughters. Some of the young would-be saints used fasting and other disfiguring methods to make themselves physically unmarriageable prospects. (For those who starve themselves do not merely become thin: they, like Sor Loreta, also develop foul breath, unpleasant symptoms of bloatedness, limp hair, dry and cracked skin. They also stop menstruating and are unable to conceive.) Others insisted on removing themselves from any possible contact with men, sometimes walling themselves up in small rooms.
Yet a rejection of burgeoning sexuality was surely not the fasters’ only motive. Nor does it seem likely that adolescent self-starving can be retroexplained satisfactorily by Freudian and post-Freudian theories about anorexia: those neatly summarized by Rudolph M. Bell in his excellent Holy Anorexia (1985) as ‘refusing an oral impregnation fantasy involving the father’s incorporated phallus’.
For many of these girls also rejected family life altogether, striking out for independence. Or they took refuge in a convent, where they would no longer be subject to domestic chores imposed by parents or husbands. Stories of some female saints show them in violent conflict with their parents, particularly their mothers. In extreme cases, mother–daughter rivalries would be conclusively settled by the death and sainthood of the younger woman.
Nuns, married to God, had different relationships with food from those of their sisters who were married to men. Firstly, fasting or eating special foods were part of a nun’s ritual and faith. The central, symbolically charged role of food would no doubt attract young girls to whom food – or the avoidance of it – had become something of an obsession. Some religious women devoted themselves to the poor, taking on motherly feeding responsibilities for them. And several female saints were credited with replicating or imitating Christ’s food-stretching miracles for the starving. Scarcely credible feats of energy were also attributed to these women in such pastoral activities. (Sor Loreta, born at Cuzco’s high altitude, would have been naturally endowed with a powerful heart and extremely large lungs.) Yet many saints who concerned themselves with feeding others paradoxically chose to starve themselves and deprived themselves of sleep, often in cruel and unusual ways. Benvenuta Bojani, for example, would bathe her eyes in vinegar to keep herself awake.
Given that dramatic food-orientated self-mutilations were really over by the mid-sixteenth century, I would argue that in the time when this novel is set, a propensity of young girls towards ecstatic visions and obsessive worship might also have been a sign of a lack of emotional maturity, fatally combined with a fierce pheromonal surge of competitiveness. And a convent could be a hothouse of all such feelings.
The end result of dramatic fasting, whether inside or outside the convent, was that the girls became dangerously thin. Some additionally flagellated themselves or invented other scarifying penances for their flesh, such as sleeping on bundles of thorns. The reason and desired outcome for all these tortures, according to the fasters, was to unite themselves with Christ, by sharing his torments. But there was another, more tangible result. Such dramatic self-torture drew attention to the sufferer. A saintly woman reduced to an asexual child’s proportions, perhaps mutilated at her own hand, might receive veneration for her piety.
There’s no doubt fasting captures the public’s imagination, now as then. Disempowered men have also used hunger-striking to make a point: the IRA and Gandhi, for example. Although fasting is no longer theologized in the Christian faith, it remains a way to draw attention – sometimes reproving, sometimes covertly admiring – to those who practise it. Today’s size-zero models and actresses are rewarded with massive publicity for their ability to abstain from food. The gossip columns also like to record which stick-like starlet partied ’til dawn: another echo of the saints who deprived themselves of sleep and yet sho
wed frenetic energy.
There has been much discussion as to whether the chaste, self-harming, starving female saints were early sufferers from anorexia. However, mediaeval women were not under cultural pressure to look thin: emaciation was not thought beautiful. Dieting to reduce weight was unknown. In those days, breasts symbolized food and feeding: today the prevalent iconography is erotic.
True parallels cannot be drawn between the present and an age without anaesthesia of any kind, antisepsis or birth control. Today’s woman is offered products to make her thinner, to suppress any pain, to avoid conception. She is urged to eat a variety of aspirational food, such as (ironically) ‘extravirgin’ olive oil and organic products – whereas would-be saints like Santa Catalina desired to feed only from Christ, treating his wound as a breast, becoming joyfully inebriated with the blood that they drank.
Certainly, some of the female saints showed symptoms that we would today quickly label anorexia or bulimia. And it’s interesting to note that many of the fasters saw their not-eating as an illness – it was described so by the biographers of Colette of Corbie, Walburga, Joan the Meatless, Alpaïs of Cudot and Santa Catalina herself. There’s a superficial correspondence between saintly fasting and modern anorexia in the physical symptoms of starving: sleeplessness, dangerously low pulse, bad breath, light-headedness, tactile insensitivity, euphoria and depression. However, as Caroline Bynum explains, it is not possible to know if spiritually led fasts caused the symptoms we now know as anorectic, or whether fasting was a result of physical illness or any of the psychological manifestations that are currently ascribed to both the symptoms and the causes of anorexia: self-hatred, anger and masochism.
Sor Loreta’s feeling on marriage – that it would be like martyrdom by being tied to a rotting corpse – was actually proposed by the Spanish writer Pedro Galindo, in his Excelencias de la castidad y virginidad (1681).