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Psychiatric Science and Lay Perspectives


Akihito Suzuki (Keio University)
Psychiatry in the Public and the Private Spheres

As Michael MacDonald famously wrote in his Mystical Bedlam, insanity has been defined by experts but discovered by laymen. More than any other diseases, madness is a two-sided affliction, straddling tenuous boundaries between the realm of law, public policy, and psychiatry, as publicly accountable practice based on science on the one hand, and the sphere of the family, domestic relationships, and private interests on the other. When the treatment and confinement of the insane became a matter of public and medical concern in England and many other European and non-European countries in the nineteenth century, the two-sidedness of madness intensified, resulting in intense negotiations and reformulations of the boundaries between the public and the private spheres. This paper will highlight some aspects of these negotiations over mad persons, namely those between the family and psychiatrists, the family and public authorities, and the family and the crowd on the street. 

Joseph Melling and Pamela Dale (Centre for the History of Medicine, University of Exeter)
Family Matters? Families, Kinship and Domesticity in Recent Scholarship on the History of Insanity

For many years the debates in the history of madness were mainly concerned with issues of class, social control and institutional discipline. References to the work of Andrew Scull if not Michael Foucault were the launching point for numerous studies of psychiatry, insanity and lunatic asylums, including Roy Porter’s critical reassessment of mad houses in the post-Restoration years. More detailed research into particular institutions and the use of demographic evidence as well as statistical data collection from various institutional sources has provided the resource for a substantial revision of earlier interpretations. The new research in the social and cultural history of insanity has also been strongly influenced by Walton, Finnane, Porter and others in addressing the question of family relationships in the care and the institutionalisation of those identified as lunatics. Important contributions include recent publications by Hilary Marland, David Wright and particularly Akihito Suzuki, whose new book Madness at Home, is an important focus of this workshop. 

In our presentation we would like to consider the implications of this valuable new research and offer some constructive criticisms of the arguments which have been presented by historians concerned with family connections and more particularly with the domestic sphere in the identification of the mad. In recent years work on the role of educated women in the nineteenth-century (including the governess) has further problematicised the nature of domesticity, as well as the opportunities for women to find a platform. Comparisons of public and voluntary-funded (as well as private) asylums suggest that the identification and treatment of the insane governess involved a complex set of relationships, calculations and choices which involved a range of actors beyond as well as within the kinship network of “families or friends”. 

The capacities and needs of those individuals identified as educationally and personally defective or deficient were seen as very different from the aspirations of the female (and male) educator in the nineteenth and early twentieth centuries. Yet the specialist institutions developed for ‘idiots’, ‘imbeciles’ and ‘mental defectives’ before 1929 offer interesting parallels with lunatic asylums (later ‘mental hospitals’). Our research suggests again the presence of a range of actors in the ‘community’ as well as institutional life, including groups of institutional leaders, non-medical staff, voluntary workers and helpers who might collectively be termed ‘lay professionals’.

Our approach is to offer a critical challenge to the burgeoning literature on families and domestic space in the new history of insanity. There is some tendency among scholars to emphasise the dichotomy between the family and the institution, the lay and the medical, the voluntary and the professional. We do not suggest that the recent literature simply revives an outdated polarity between caring families and institutions as the warehouses of the abandoned and the incurable. What we seek to open up for further discussion is the implication that family relatives were a consistent and important presence in ‘casting out’ and ‘bringing back’ lunatics. Narrowing down our focus to the family as the prime movers in the care, committal and discharge of the insane threatens to obscure the host of other actors who figured in the process of care as well as institutionalisation. In presenting an alternative view, we also to reiterate the importance of class and power inequalities found in some earlier studies while also exploring the changing meanings of public and private, domestic and social, institutional and communal in the later nineteenth and early twentieth centuries.

Pamela Michael (University of Wales at Bangor)
‘Relatives Affected’: A Comparison of Lay and Professional Interpretations of the ‘Hereditary Origins’ of Insanity amongst Patients Admitted to the Denbigh Asylum, 1875-1914

Hereditary causes featured predominantly amongst the ‘supposed predisposing causes’ leading to the insanity of patients committed to the North Wales Lunatic Asylum at Denbigh during the late nineteenth century. Information on the family background of patients was obtained from relatives and officials with intimate knowledge of the family. The attribution of hereditary causes depended on the transmission of information between lay members of the family (or their associates) and medical professionals capable of diagnosing the ‘disease’. Taking the case histories of a 10% sample of patients admitted between 1875 and 1914, a positive identification of relatives affected was reported in 178 of the sample of 550 patients. Sometimes it was a brother, sometimes a ‘mother, aunt and cousins’ who were affected, and occasionally the admission form records that ‘the whole family are considered rather peculiar’. The lay reportage of signs of insanity displayed by patients prior to committal conveys a notion of family members and observers struggling to make sense of displays of madness and erratic behaviour. In offering explanations that refer to the behaviour of other members of the family they are constructing a ‘family script’. This lay attribution feeds into the medical encounter and informs the professional practice of constructing a ‘disease aetiology’. When a cluster of cases of religious insanity coincided with the great religious revival of 1904-5, medical staff at the Denbigh Asylum reported that ‘underlying hereditary causes’ were at the root of the individual cases identified in this social phenomenon. The medical superintendent and his staff also identified a strong link between tuberculosis and insanity. Their medical authority was based not only on the writings of alienists such as Thomas Clouston and Robert Armstrong Jones, but was supported and validated by the stories they received from lay informants about the manifestations of ‘madness at home’ in the prelude to committal procedures. This paper will recount some of these stories of ‘madness in the family’ and explore the lay/professional encounters in north Wales during later portion of the nineteenth century.

Jette Møllerhøj(University of Copenhagen and Visiting Research Fellow, Lucy Cavendish College, University of Cambridge)
On Unsafe Ground:The Practices and Institutionalisation of Danish Psychiatry 1850-1920

My presentation will focus on the endeavours of late 19th-century psychiatrists to have their field of work recognised as a discipline in its own right and their struggle to be accepted as performers of science in accordance with common scientific standards of exactness and proof.

This struggle took place on two battlefields: firstly, in relation to colleagues within the somatic branches of medicine, especially the neurologists who constantly criticised psychiatrists for being subjective, vague and unscientific, and secondly, in relation to lay people and the surrounding world of psychiatry. According to psychiatrists, laymen persistently contested psychiatry’s legitimacy in diagnosing and treating mentally ill patients. The psychiatrists explicitly aimed at getting connected with the mainland of scientific medicine. The criticism of the scientific objectivity as well as the laymen’s attention to psychiatric practices caused difficulties in gaining respect on equal footing with other branches of medicine. As a consequence, psychiatry remained on unsafe ground.

Cecilia Riving (University of Lund and Visiting Fellow, Centre for the History of Medicine, University of Warwick)
‘I would love to see my daughter again’: The Family and the Psychiatrist in 19th-Century Sweden

The aim of my thesis is to analyse interpretations of mental illness in Sweden in the second part of the 19th century. My main interest is the relationship between lay and medical interpretations of insanity. Through a parallel reading of admission certificates and patient files it is possible to compare definitions of mental illness put forward, on the one hand, by people in the local community and, on the other hand, by asylum doctors. My hypothesis is that lay and medical attitudes towards madness constantly influenced each other and that lay perspectives were essential for making medical judgments – this particularly so during the period when Swedish psychiatry was struggling to establish itself as a medical science. Descriptions of the patient’s social behaviour, given by people in the local community, played a large part in the medical judgment. This proved a huge dilemma for alienists, who sought to achieve the same objective, scientific standards as those held by somatic medicine.

My presentation will focus on a case study from a Swedish asylum, which highlights some of the aspects relevant to my area of research. The case gives an interesting insight into the practical interaction between the asylum doctor and the relatives of the confined patient. With this example as empirical background I attend to put forward some suggestions on how the relationship between lay attitudes and psychiatric science can be interpreted, and how this historical perspective is useful too for an understanding of modern psychiatry. 

Hilary Marland (Centre for the History of Medicine, University of Warwick)
Healers of the Household: Doctors, Families, Patients and the Treatment of Puerperal Insanity in the Nineteenth Century

It could be argued that puerperal insanity, more than other forms of mental disorder, was situated at the heart of family affairs and fortunes. It afflicted women at a moment which – in normal circumstances – was depicted as a time of great happiness and personal and family fulfilment, following the birth of a child. It was also unusual in that it engaged the attention of obstetric practitioners as much as psychiatrists for much of the nineteenth century, and for the fact that many doctors recommended treating it in domestic settings rather than the asylum. Doctors writing on the condition framed its occurrence as a double tragedy and affliction, involving mental breakdown and breakdown of the household and domestic and maternal ideals. Family values and lay interpretations of events and the condition also strongly shaped the ways in which puerperal insanity was described and remedies sought in published case notes and textbook accounts.

This paper will explore the presentation of puerperal insanity as a family crisis as much as a mental condition. At the same time, given the contested nature of claims of expertise, doctors were also keen to demonstrate as well as a sympathetic and healing approach, a professional and scientific understanding of the condition and ways of treating it. It is this tension between self-presentation as learned and impartial men of science and conscientious family physicians, sensitive to the acutely disrupting force of this condition on the household and the need to respond to family concerns, that will be the main focus of this paper.