Literature and Psychology

I often think of Emma Bovary.

In 1856, Gustave Flaubert’s first novel was helped along in sales by a trial for obscenity. And yet the school of thought Flaubert embodied was called “literary realism.”

I read it shortly before I went to medical school. The way literature saw medicine was the antithesis of the romantic view of medicine that propelled me from my continent to France for my medical education.

In the classics of French literature which I had the joy of reading in the original and which spanned a couple of hundred years, often the doctor was a charlatan, a materialist — maybe even a bit of a buffoon.

The character of Mme. Bovary, the doctor’s wife, is a person who dramatizes her emotions lavishly, fears abandonment. She is elegant and clearly outclasses the clumsy doctor. Her sophistication covers her infidelity for she tells the doc she is off taking piano lessons. She goes into debt for luxuries, and eventually commits suicide. He finds her illicit love letters and ends up badly off and finally, dead.

The story captivates still. Since nobody reads books any more, here is a recent French movie of it.

But why would I think of her often?

Not because she was sympathetic, for she is not.  I think of her as the perfect embodiment of Borderline Personality Disorder.

It is even more amazing that I cling to this thought in an era of great controversy about psychiatric classification systems.

Flaubert’s character could have been the woman with Borderline Personality Disorder who presented a few days ago in my office.

Her husband could have been one of my classmates.

Flaubert could have been a damned good psychiatrist, for this woman was real to him.

I think most of great heroines of literature are borderlines, for a creator with a sense of humor seems to have made them wickedly attractive in truth as fiction.

In truth, Marilyn Monroe.

In fiction, Scarlett O’Hara.

The deepest truth is revealed in literature. I have amused myself by seeing other psychiatric diagnoses in literature.

As long as our diagnostic systems are mired in behavioral realities, to make them useful to insurers and politicians, they will be less than literature can be, and surely is, in the hands of Flaubert.

A great diagnostic system will someday include our neurochemical knowledge, to be most effectively used by those who study the brain.