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Madness at Home

Madness at Home: The Psychiatrist, the Patient, and the Family in England, 1820-1860

Akihito Suzuki
Copyright Date: 2006
Edition: 1
Pages: 272
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  • Book Info
    Madness at Home
    Book Description:

    The history of psychiatric institutions and the psychiatric profession is by now familiar: asylums multiplied in nineteenth-century England and psychiatry established itself as a medical specialty around the same time. We are, however, largely ignorant about madness at home in this key period: what were the family’s attitudes toward its insane member, what were patient’s lives like when they remained at home? Until now, most accounts have suggested that the family and community gradually abdicated responsibility for taking care of mentally ill members to the doctors who ran the asylums. However, this provocatively argued study, painting a fascinating picture of how families viewed and managed madness, suggests that the family actually played a critical role in caring for the insane and in the development of psychiatry itself. Akihito Suzuki’s richly detailed social history includes several fascinating case histories, looks closely at little studied source material including press reports of formal legal declarations of insanity, or Commissions of Lunacy, and also provides an illuminating historical perspective on our own day and age, when the mentally ill are mainly treated in home and community.

    eISBN: 978-0-520-93221-0
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
    (pp. xi-xii)
  5. Introduction: Psychiatry in the Private and the Public Spheres
    (pp. 1-11)

    THIS BOOK EXAMINES THE SOCIAL history of madness from the perspective of the family. I have chosen the family as my main subject for two reasons—first, because family members historically have been important actors in psychiatric decision making, and second, because they are now assuming vital roles in social policies for the mentally ill in many developed countries. Mental diseases, particularly in their more severe forms, impair the sufferer’s ability to make proper decisions for and by him-or herself. The patient often fails or refuses to realize the very fact that he or she is ill. Therefore, recognizing the...

  6. ONE Commissions of Lunacy: Background, Sources, and Content
    (pp. 12-38)

    IN FEBRUARY 1823, THE READING public of England was shocked by the disclosure of yet another scandal in high places.¹ The major dramatis personae of the scandal were the third Earl of Portsmouth, his second wife, Mary Anne, and her lover, William Rowland Alder. Lord Portsmouth was born in 1767 and married Grace Norton in 1799. Grace died in 1813, and less than four months after her death, Lord Portsmouth married Mary Anne Hanson. Mary Anne was the eldest daughter of John Hanson, who was an attorney and Portsmouth’s principal trustee.² Alder was a lawyer who had been acquainted with...

  7. TWO The Structure of Psychiatric Practice
    (pp. 39-64)

    IN AUGUST 1827, ALEXANDER MORISON, who had recently started to practice psychiatry in London, received two sets of letters, informing him of the mental disease of Mary and Helen M——. Each set contained two letters, one from the sister of Mary and Helen, the other from Dr. Davidson, who had visited the sisters at the licensed house of Dr. Stewart, where they had been kept.¹ The contrast between the sister’s narrative and that provided by the doctor is striking. The sister gave seven pages of detailed accounts of Mary and Helen’s personal circumstances, in which she presented her...

  8. THREE The Problems of Liberty and Property
    (pp. 65-90)

    THE PREVIOUS CHAPTER APPROACHED a familiar question of psychiatrists’ misdemeanors from a new perspective. Instead of attributing incidents of wrongful confinement to the lack of professional conscience or legal regulation, I attempted to uncover the epistemological structure underlying psychiatric practice. The practitioner’s trust of family members and the high status accorded to information they provided were key factors in the cases of Anderdon and Davies. Alienists had two kinds of information that helped them to judge whether the person in question was insane or not: what they observed in the patient and what they heard from the patient’s family. They...

  9. FOUR Managing Lunatics within the Domestic Sphere
    (pp. 91-118)

    THE PREVIOUS TWO CHAPTERS ANALYZED the primacy of the family in psychiatric practice. Practicing psychiatrists were often integrated into family affairs, largely playing an ancillary, if not always subordinate, part. Their more or less dependent position vis-à-vis the family marks a strong contrast to their claims to professional autonomy based on scientific medical expertise, so much trumpeted in the pages of medical treatises and articles. Psychiatrists could not live up to their scientific aspirations for several reasons. One reason was the obvious advantage enjoyed by the family because of their intimate knowledge of the insane family member. Another reason was...

  10. FIVE Destabilizing the Domestic Psychiatric Regime
    (pp. 119-150)

    CHAPTER 4 EXAMINED THE POWERFUL resources of domestic psychiatry. Centered on the notion of the family as a close-knit community of individual personalities bound together by mutual affection, a framework emerged for decoding and understanding insanity, as well as a set of strategies for the management of lunacy at home. Both the framework and the strategies were constructed around the power of personal influence exercised by those who knew the patient intimately and who could inspire the patient to “unbosom” his or her internal sufferings. This confessional practice was modeled after Evangelical family gatherings. Perhaps it became a prototype of...

  11. SIX Public Authorities and the Ambiguities of the Lunatic at Home
    (pp. 151-178)

    IN CHAPTER 5, I EXAMINED those cases that reveal the limits of domestic measures to control lunatics. Families’ attempts at containing the mentally disturbed were often seriously undermined and threatened by a multitude of factors: by the unruly behavior of the lunatics themselves; by internal discord among the family; by the intrusion of a curious crowd in public spaces; by the protest of lunatics who sought to free themselves from domestic surveillance and control; and by the actions of interested outsiders who wanted to take advantage of the incapacity of the lunatics. To cope with these problems, the family had...

  12. Conclusion
    (pp. 179-184)

    THIS BOOK HAS EXAMINED FAMILIES’ strategies for understanding, coping with, and managing insane family members, roughly from 1820 to 1860, a period that coincided with the rise of psychiatry and of the asylum. I have analyzed both the internal dynamics and the external relations of families with insane members. My account has naturally included both the intrafamilial tensions and the intersections of the family and various agencies in the world outside, such as doctors, crowds on the street, and public authorities. In so doing, I hope that I have established the family as the major protagonist in matters related to...

  13. APPENDIX List of the Reports of Commissions of Lunacy in the London ‘Times,’ 1823–1861
    (pp. 185-190)
  14. NOTES
    (pp. 191-232)
    (pp. 233-248)
  16. INDEX
    (pp. 249-260)