Rachel Moran, ‘Making Sense of Postpartum Politics’: Blue: A History of Postpartum Depression in America

In the first of our guest blogs Associate Professor Rachel Moran introduces her path-breaking new book, Blue: A History of Postpartum Depression in America (Chicago, IL: University of Chicago Press, 2024), which explores the history of postpartum mental illness in 20th and 21st century America.

In 1930, writer Emily Holmes Coleman published a novel, The Shutter of Snow, partially based on her postpartum psychosis and institutionalization a few years earlier. When men at the time reviewed the book, they made no secret of their distaste for both Coleman’s artistic choices and her choice of subject. “The gentleman reader cannot fairly be expected to work up a professional interest” in this story of a woman’s insanity, one wrote. Another complained that “It is difficult to see the point” of such a book.[1] Around the same years, American psychiatrists showed only slightly more interest and a similar amount of skepticism about postpartum mental illness. They debated whether postpartum insanity differed from other insanity, whether it merited special attention and its own diagnosis. Most concluded it did not.[2]

Fifty years later, the situation was quite different. By the late 1980s, there was an organized network of self-help groups and a specialized organization for medical professionals interested in the postpartum. Psychiatrists sat next to mental health activists on television programs like Donahue and Oprah, introducing postpartum mental illness to the American public. The combination of mothers’ emotional stories and psychiatrists’ legitimizing explanations proved popular with 1980s audiences familiar with depression and primed to question American motherhood.

By the early 2000s, specials about postpartum depression required even less of an introduction in the United States. Celebrities, including Brooke Shields and Marie Osmond, published memoirs about their depressions.[3] Bipartisan legislation called for increased depression screenings for new mothers. Postpartum mental illness had arrived as a mainstream women’s health issue.

I set out to make sense of the last hundred years of American postpartum politics, and understand the forces behind these changes in how we think and talk about postpartum depression and psychosis. My new book, Blue: A History of Postpartum Depression in America (Chicago, 2024) considers this transformation in postpartum mental health between the early-20th to the early-21st centuries, with a focus on the period from 1945 onwards. The book engages with women’s and gender history, medical history and the history of the psy sciences.

Records of women’s postpartum mental health problems can be traced back much earlier than my focus, and historians (and activists) have made fascinating arguments about the postpartum mental illnesses of women in Hippocrates’ writings, or of a figure like Margery Kempe in the Middle Ages.[4] Other historical work considers the 19th-century diagnosis of puerperal insanity or lactational insanity, and its relationship to gender and medicine of the time.[5] There is no shortage of stories to tell about women’s suffering and the relationship between motherhood and madness.

For this book project, I was drawn to questions of how postpartum illness could move from taboo to mainstream between the mid-to-late-20th century, and how that trajectory related to other changes in American feminism, women’s health, and medicine. While the book covers earlier developments briefly, it begins in earnest with a discussion of the idea of the “baby blues” in the post-1945 period. The baby blues was a concept often wielded against women, it was dismissive of women’s experiences and borrowed from Freudian ideas about women’s immaturity and difficulty with role adjustment. At the same time, though, the articulation that American motherhood could be difficult offered an entering wedge for challenges to the institution in the coming years.

In the 1970s, feminists increasingly spoke of postpartum illness as evidence of problems in motherhood. If motherhood was women’s natural state, they argued, why were so many women unhappy? Why would women, occasionally, even kill their children? While some women’s health activists sought medical attention to postpartum illness, some natural birth activists argued depression was evidence of the problems of modern birthing and would not exist otherwise. Other feminists found that postpartum illness was most useful as a metaphor, not as a medical condition. No defined feminist stance of postpartum mental illness emerged.

It was only in the 1980s that postpartum advocacy took off in the US context (it emerged slightly earlier in the UK and Canada). Using oral histories with advocates and clinicians, I tell the story of how the idea of postpartum mental illness gained attention among fringe psychiatrists and psychologists in the early part of the decade, alongside (and often quite entangled with) women’s grassroots advocacy in the same years. The book looks at issues like the politics of diagnosis, the role of the mass media and television, and the relationship between postpartum psychiatric and psychological professionals and postpartum advocacy.

It is notable that the height of the women’s health movement was a modest time for postpartum mental health activism, while it thrived in the more politically conservative 1980s. I wanted to make sense of this tension, and to think about what it says about the past and present of postpartum health. Was the rise of this advocacy in the 1980s a surprising triumph for women’s reproductive concerns against a backdrop of anti-abortion organizing and retrenchment? Or was it actually a conservative containment of motherhood, a way of medicalizing anything that challenged the idealization of motherhood? Was calling women’s suffering “hormonal” a way of getting attention and treatment, or a way of trivializing it?[6]

I argue that in the 1980s and 1990s, advocates often adopted biology-focused, politically neutral explanations of women’s mental illness. This was in part a reaction to a conservative political climate. It was also in part a reaction to the failure of earlier feminist activism to agree on how to conceptualize postpartum illness. And, in many ways, it was simply a natural consequence of the most invested individuals often also being medical professionals themselves, who took women’s suffering seriously through the language of medicine.

In the book, I consider the way this construction of maternal mental illness was implemented, and its success in allowing for a broad, medicalized acceptance of postpartum illness. But I also think about the limits of the approach, especially in the final chapter. The imagination of “good motherhood” damaged by mental illness often focused on a middle-class white motherhood that made coalition building across race and class difficult. It also limited opportunities for some of those earlier feminist projects of using maternal distress to critique motherhood. When so much energy went into explaining that mothers with postpartum distress were still “good mothers,” it often reinforced ideas about what good motherhood meant.

As I wrote the book, I struggled with telling as complete a story as I wanted to while still making it compact and readable. I think of so many interviews I did with amazing people, where I only used one sentence, and of so many rabbit holes I went down and then had to cut everything I wrote out. This is a familiar story for all writers, of course, but was hard when there is limited writing on the history of postpartum depression in the US out now.[7] I am proud of all I believe Blue brings to this conversation, and also inspired by the idea it will be joined by all kinds of work currently underway. There is so much at stake in the study of women’s postpartum mental health, and so many angles to still be explored.

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ENDNOTES

[1] Carmen Callil, “Introduction,” Emily Holmes Coleman, The Shutter of Snow, Virago Modern Classics (New York: Virago Press, 1986).

[2] Edward Strecker and Franklin Ebaugh, “Psychoses Occurring During the Puerperium,” Archives of Neurology & Psychiatry, 15 (1926): 239–52; Gregory Zilboorg, “Malignant Psychoses Related to Childbirth,” American Journal of Obstetrics and Gynecology, 15 (1928): 145–58.

[3] Brooke Shields, Down Came the Rain (New York: Hyperion, 2005); Marie Osmond, Behind the Smile: My Journey out of Postpartum Depression (New York: Warner Books, 2001).

[4] P.R. Freeman, C.R. Bogarad and D.E. Sholomskas, “Margery Kempe, A New Theory: The Inadequacy of Hysteria and Postpartum Psychosis as Diagnostic Categories,” History of Psychiatry, 1 (1990), 169–90.

[5] Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (Houndmills: Palgrave Macmillan, 2004); Nancy Theriot, “Diagnosing Unnatural Motherhood: Nineteenth-Century Physicians and ‘Puerperal Insanity,” American Studies, 30 (1989): 69–88.

[6] Amy Koerber, From Hysteria to Hormones: A Rhetorical History (University Park, PA: Pennsylvania State University Press, 2018).

[7] Critical, must-read exceptions are: Rebecca Godderis, “Motherhood Gone Mad? The Rise of Postpartum Depression in the United States during the 1980s,” in Body Subjects: Essays on Gender and Health 1800–2000, ed. Tracy Penny Light et al. (Montreal: McGill Queens University Press, 2014), 303–18; Rebecca Godderis, “A Tricky Object to Classify: Evidence, Postpartum Depression and the DSM-IV,” Journal of the History of the Behavioral Sciences, 49 (2013): 123–41; Rebecca Godderis, “Iterative Generation of Diagnostic Categories Through Production and Practice: The Case of Postpartum Depression,” Culture, Medicine, and Psychiatry, 35 (2011); N. Dubriwny, The Vulnerable Empowered Woman: Feminism, Postfeminism, and Women’s Health (New Brunswick, NJ: Rutgers University Press, 2013).

‘Women, Reproduction and Mental Illness in the “Long” Twentieth Century’: A Two-Day Workshop, University of Warwick

'A Mother and Child in a Maternity Ward', (1962) Credit: Wellcome Collection.

On 8-9 April 2024, we hosted our final project workshop at Warwick, exploring the theme of ‘Women, Reproduction and Mental Illness in the “Long” Twentieth Century’. Over the two days, participants presented on a wide range of topics related to motherhood and mental disorders, mental illness around menopause, teenage motherhood, and the relationship of mental illness to abortion and infertility. Although the subject of women’s mental health and reproduction has engaged historians, sociologists and feminist and literary scholars since the 1970s, the papers presented at the workshop built on these earlier insights in novel and engaging ways. The workshop papers explored how understandings of reproduction and mental illness were shaped by gender and sexuality, social class, religion, politics and activism, war, institutional practices, crime and violence, and the media. They also considered how society identified and responded to mental illness among women and how far diagnosis and explanations of mental breakdown were shaped by social, cultural, emotional and medical factors, as well as the interventions of different agencies and experts, women themselves, their families and communities, voluntary organisations and medical institutions. The papers opened up questions about how feminist health campaigns and organisations lobbying for change in policy, legislation and service provision explained mental illness among women and, in some cases, utilised explanatory frameworks of risk to mental wellbeing to underpin and strengthen their campaigns.

The workshop was organised under five themes, across the two days.

DAY ONE

Mothers, Violence and Mental Illness

Our first session opened with Alison Pedley’s (University of Roehampton) analysis of Broadmoor case files, family letters and press reports. Alison explored the varied responses of women who had killed or attempted to kill one or more of their children during their incarceration, and the often sympathetic, supportive and caring roles of family members. Alison highlighted how crucial family ties and support were in maintaining contact with female relatives in Broadmoor and pressing for their loved one’s release from the institution. She also drew on Sian Busby’s account in The Cruel Mother (2004) of her great grandmother Elizabeth (‘Beth’) Wood, who drowned two of her babies in 1919 and spent two years in Broadmoor. The life stories Alison presented revealed the lasting emotional impact of such calamitous events on family life.

Louise Benson James’ presentation (University of Ghent) provided a literary analysis of two novels by the modernist writer Djuna Barnes, Ryder (1928) and Nightwood (1936), examining what fiction can tell us about the perceived relationship between reproduction and mental health in the interwar period. Louise argued that these texts took a defiantly and vehemently anti-procreative stand, incorporating graphic visual and textual depictions of pregnancy and birth. The first novel, Ryder, described the impact of excessive pregnancies and painful traumatic births, resulting in death and madness. In Nightwood, the response of the protagonist, Robin, to pregnancy and birth prompted physical and mental wandering, dysmorphia, body horror and infanticidal tendencies, with the novel also highlighting dominant social concerns about heredity and inherited mental weakness.

Citing several well-documented cases, Kelly-Ann Couzens (University of Warwick) examined maternal mental illness and crimes against children during the Second World War in England and Wales, posing the question: what made war distinctive in terms of infanticide? Kelly began her paper by noting the doubling of cases of infanticide and concealment and the appreciable rise in trials for infanticide following the passage of the Infanticide Act of 1938 and the social upheavals caused by the war. Highlighting the importance of press reports as a source, Kelly-Ann argued that infanticide was increasingly being understood within the press and in the courtroom as reflective of broader anxieties about the decline in morals and mobilisation of women in response to the war. The war also saw a change in the location of crime scenes outside of domestic spaces and a highly liberal application of the defence that women accused of these crimes were mentally ill.

Cover of Siân Busby's The Cruel Mother (2004)

Diagnosing and Understanding Mental Disorder

Hilary Marland (University of Warwick) opened the next session with her exploration of changes in diagnosing maternal mental illness around 1900, when the Victorian classification ‘puerperal insanity’, which linked mental breakdown resolutely to the experience of childbirth, began to be questioned. Drawing on evidence from two London asylums, Claybury and Colney Hatch, she examined the very different approaches adopted within these institutions to categorising and explaining mental illness postpartum. While Claybury clung tenaciously to the Victorian definition, Colney Hatch quickly adopted new psychiatric terminology, framing childbirth merely as an associated cause of mental breakdown. In continuity with Alison’s paper, Hilary highlighted the central role of the family in shaping institutional responses to maternal mental illness. In particular, she explored how family members might intervene to offer their own explanations of the woman’s mental breakdown, associating this with difficult childbearing careers, painful deliveries, miscarriage and the deaths of young children.

Drawing upon a rich array of official reports, medical texts, journals and asylum records, Jenny Smart (University of Cambridge) explored the increasing incidence of, and medical interests in, insanity related to the ‘climacteric’ or ‘change of life’ from the middle of the nineteenth century, but most markedly in the last quarter. This trend stood in contrast to the growing challenges the diagnosis of ‘puerperal insanity’ faced in the same period.  Drawing on the examples of Derbyshire and Norfolk pauper lunatic asylums, Jenny questioned how far climacteric insanity was associated with reproduction or ageing. She argued that, despite it increasing prevalence, the disorder did not become a 'default' diagnosis for middle-aged working-class women and that it was associated with the violation of norms of femininity, community and family, as well as the medicalisation of the female body.

Udodiri Okwandu presenting her paper 'The War on Postpartum Psychosis: Dr Elizabeth B. Davis, Family Planning and Racial Uplift in 1960 Poor, Black Harlem'.

DAY TWO

Activism, Advocacy and Agendas

Laura Kelly (University of Strathclyde) explored how, in the 1980s, post-abortion syndrome (PAS), characterised by feelings of guilt, regret and depression, began to be weaponised by Irish anti-abortion activists, including prominent members of the Catholic Church, who viewed abortion as a threat to motherhood. Drawing on archival sources, the publications of anti-abortion groups and medical professionals and press accounts, Laura highlighted how the Irish anti-abortion movement and PAS were strongly shaped by American anti-abortion campaigners. Two key groups, the anti-abortion counselling service CURA and Women Hurt by Abortion, consistently highlighted the risk of PAS by utilising women’s own testimonies to present themselves as compassionate and acting in women’s interests, situating women seeking abortions as ‘victims’ rather than ‘murderers’.

Turning to the United States, Udodiri Okwandu (Harvard University) described how the emphasis on family planning as a solution for poor childbearing women experiencing postpartum psychosis reinforced the pathologisation of Black mothers in major urban centres in the 1960s and 1970s. Focusing particularly on the work of Elizabeth Bishop Davis, a Black American psychiatrist and psychoanalyst working at Harlem Hospital Center, Udodiri demonstrated how a strong association was made between maternal mental illness and the cycle of poverty by health professionals who advocated racial uplift using female sterilisation. Udodiri argued that far from offering a solution to poverty and the strains placed on women with large families, this approach instead mirrored and reinforced eugenic approaches, while also erroneously propagating the idea that postpartum mentally ill women were poor, urban, hyper-fertile and Black.

Continuing the theme of advocacy, Rachel Moran’s (University of North Texas) presentation explored the role of women therapists working in postpartum mental health in the late 1980s and early 1990s, describing how, for many, their own postpartum distress had prompted interest in the subject. Drawing on extensive oral histories and the archives of advocacy groups, Rachel showed how these women built their careers by combining practice with media appearances and education. They also established several activist groups, notably Postpartum Support International (PSI) and Depression After Delivery (DAD), and came to play leadership roles in these organisations. Rachel’s paper also analysed the extent to which the work of these activists was linked to feminist ideas, noting that as white middle-class women, their focus and practice were embedded within their own class and directed toward paying patients. Rachel also highlighted how the approaches adopted by these women therapists displaced non-professional women activists and sped up the medicalisation of postpartum depression in the US.

Associate Professor Rachel Moran sharing her paper 'Professionalizing the Postpartum: The Rise of Advocate Psychologists in the 1980s'.

Narratives, Testimony and Media

Zara Christmas (University of Oxford) opened the next session with a presentation on the pathologisation of teenage pregnancy in late twentieth and twenty-first century England. Drawing on expansive interview testimonies, autobiographies and media accounts, she placed teenagers’ thoughts and feelings about their pregnancies at the centre of her analysis, showing how their views diverged from the problematised and stereotyped accounts of teenage pregnancy propagated by media, sociologists and health professionals which dominated this period. Zara’s paper revealed the complexities of holding the dual identities of mother and teenager, the flimsy nature of mental health support and the broad and diverse responses of young mothers to their experiences of pregnancy and motherhood. Combining quantitative and qualitative data, she demonstrated how the moral panic surrounding teenage pregnancy increased in press reports despite actual numbers of teenage pregnancies dropping sharply in the twenty-first century, and her presentation also demonstrated how society stigmatised teenage mothers more than teenage fathers.

Fabiola Creed’s (University of Warwick) paper explored how features on postnatal depression were presented on BBC radio Woman’s Hour in post-war Britain. Fabiola explored how the initially ‘taboo’ subject, first discussed on-air by a medical professional in 1960, gained increased coverage in the 1970s and 1980s and was accompanied by a shift to include, and then amplify, the voices and views of women who had recovered from postnatal depression.  Drawing on BBC archives, oral history collections, autobiography and press reports, Fabiola’s paper highlighted how the programme reflected changing attitudes towards maternal mental illness, health advice, and treatment approaches more broadly, especially the role of women with lived experience in articulating and explaining mental illness.

Dr Fabiola Creed speaking at the 'Women, Reproduction and Mental Illness in the “Long” Twentieth Century’ Workshop.

Emotions, Experiences and Mental Health

Drawing largely on Mass Observation testimonies and oral histories, the final session opened with Tracey Loughran’s (University of Essex) unpacking of emotional histories of in/fertility and involuntary childlessness in Britain between the 1960s and the 2000s. Tracey set her discussion against a broader backdrop of new fertility treatments, changing attitudes towards childlessness, sexual liberation and increased reproductive agency. Taking a longitudinal approach, Tracey explored women’s attempts to narrate life histories and experiences of in/fertility, often in unsuspected places, when writing about unrelated topics. In particular, she engaged with the case study of one anonymous contributor to the Mass Observation Archive, who repeatedly spoke to the theme of infertility in her submissions to the study across her lifetime. Tracey’s paper highlighted methodological approaches and challenges in exploring how we can locate and interpret difficult stories, as well as the relationship between experience, representation, and expression.

In the final presentation of the workshop, Jill Kirby (University of Sussex) discussed the language and experiences of menopausal women from the 1970s to early 2000s in Britain. Noting that around the time of menopause, women were often described as ‘mad’, subject to mood swings, irrationality, anger, irritability and depression, Jill argued that many of the wide-ranging symptoms associated with this reproductive change were not recognised as hormonal. Drawing on women’s testimony in Mass Observation and Nova magazine, Jill examined the lived experience of mental ill health around menopause and the impact of this on day-to-day lives. Her paper also argued that despite the impact of feminism, women often confronted silence, limited support from family and the medical profession, and their own lack of knowledge and information about menopause

'Premak: The No. 1 Treatment in the Menopause Now Has A No. 2' , (1975-1979), Credit: Wellcome Collection.

Collectively, the ‘Women, Reproduction and Mental Illness in the “Long” Twentieth Century’ workshop deepened our knowledge and understanding of the complex relationship between women’s mental illness and reproduction across the twentieth century. The presentations also stimulated much discussion about using sensitive and sometimes sensational material, emphasising the difficulties in deciding how much personal information about a historical subject should be disclosed, even when this material is accessible through other formats in the public sphere. The breadth of topics, geographical settings and methodological approaches covered by the workshop papers illustrate the novel and substantive contributions being made in the historiography of women’s mental and reproductive health while also pointing to exciting avenues yet to be explored in these histories.

From a ‘transitory state of insanity’ to ‘a marked sexual degenerate’: Diagnosis, Expertise and Criminality in a 1929 Scottish Infanticide Case

On 4 August 1929, thirty-year-old housekeeper Euphemia Paton Blake, made a shocking discovery on the rural property of Easter Upper Urquhart Farm in Fifeshire, Scotland. Lying abandoned and bloodied in a cornfield known as the ‘Orchard Park’ were the remains of a female infant whose throat had been recently slit by a razor blade. In Blake’s mind, there was little mystery as to who had murdered the child. Indeed, an hour before she had made the discovery, the housekeeper had observed her employer’s daughter, twenty-one-year-old Elizabeth Cam Birrel Page, standing ‘100 yards from the house. She had no shoes or stockings on, and when she entered the house she locked herself in the bathroom.’[1] While this behaviour would have been unusual in and of itself, Blake had also noted changes in the physical appearance of Page for some months prior, leading her to suspect that the young woman may have been concealing a pregnancy. George Page senior had also been struck by his daughter’s unusual behaviour that day, recalling that when his daughter ‘came in on the day in question she was soaking wet and had a look that he would never forget. It made him speechless.’[2]

Contemporary map showing the location of the ‘Strathmiglo Child Murder’ case’ in Fifeshire, Scotland. Credit: © OpenStreetMap

At the November High Court trial before Lord Moncrieff in Dundee, evidence led by Crown counsel clearly demonstrated that Page had killed her child. However, her motives for killing were less clear. Consequently, the trial centred on the more complex question of whether she had been fully responsible for her actions at the time of the offence. Page pleaded ‘not guilty’ to the charge of murder, claiming that she was insane ‘or in such a state of mental weakness as to make her irresponsible for her actions’.[3] In support of this argument, testimony was given by three doctors, including William Boyd, medical superintendent to the Fife and Kinross Asylum, to suggest that ‘the accused was suffering from a transitory mental disorder at the time, which would render her unaccountable for her actions.’[4] The Crown made little effort to contest this defence, and a jury ‘which included five women’ acquitted Page of the charge on the grounds of insanity.[5] 

The acquittal of the ‘girl mother’ (as she was dubbed in the Scottish press) was met with applause according to The Scotsman and Page was allowed to leave the dock to join her father and friends in celebration of the verdict.[6] Yet her journey through the Scottish criminal justice system was far from over. What happened next to Elizabeth Page can be pieced together from the flurry of handwritten minutes, correspondence and medical reports, held within her prison records (HH18 series) that are now kept in the archives of the National of Records of Scotland in Edinburgh.[7] 

Exterior photograph of General Register House in Edinburgh where some of the collections of the National Records of Scotland are held and made publicly accessible. Credit: Kim Traynor, 2011 (CC BY-SA 3.0)

In correspondence between Page’s solicitor, John Campbell, to the Secretary of State for Scotland one week after the trial, it emerged that the happy courtroom scene had been quickly broken up. As Page prepared to join the crowds who waited to greet her outside the court building, authorities moved to re-apprehend and detain her in the nation’s dedicated facility for dangerous criminal lunatics, Perth Criminal Lunatic Department (CLD).[8] Given that Page had recovered her mental state following the offence and been certified as sane by prison doctors while awaiting trial, Campbell believed that the favourable trial verdict justified an ‘immediate order be issued’ for his client’s release. Yet the solicitor’s request posed a significant problem for prison authorities. Under the provisions of Section 88 of the Lunacy (Scotland) Act 1857, an acquittal on the grounds of insanity warranted the ongoing custody of Page as a criminal lunatic ‘until His Majesty’s pleasure be known’ in Perth Prison’s CLD (hereafter ‘the Department’).[9] However, Page’s admission records to the Department following her trial indicate that prison doctors continued to view her as ‘now recovered’, and thus, no longer suffering from a mental disorder.[10]

From mid-November to early-December 1929, Scottish prison and state officials pondered the question of what to do with Elizabeth Page. In cases where an insane inmate no longer presented a danger to the public, transfer to an ordinary asylum could be warranted. Alternatively, conditional liberation could be conferred when a detainee was considered by authorities to be well enough to be released back into the community. Such “liberation” was far from total for former prisoners however, and encompassed years of ongoing restriction and supervision by carefully appointed guardians and prison doctors.[11] The shortest period an inmate had spent in the Department before conditional liberation had been granted was one year and six weeks, for the lesser offence of assault to the danger of life.[12]  Although prison doctors regarded Page as sane, John Lamb, Permanent Under-Secretary of the Scottish Office, noted that no recommendation for her conditional liberation had been made by medical or prison staff. Moreover, it was felt that ‘serious work in making any exception in the present case’ would need to be undertaken to instigate Page’s conditional release. Given the seriousness of her offence, the lack of precedent in a comparable case and the evident unwillingness to trigger the mechanisms for release, Page remained incarcerated in the Department.

1937 bromide print of Sir John Lamb by Walter Stoneman. Credit: © National Portrait Gallery, London (CC BY NC ND)

However, Page’s family also sought her release. On 3 March 1931, Page’s brother, John Page junior, wrote to Scottish authorities asking if his sister’s ongoing incarceration might be reviewed once more. Page junior felt that his sister’s crime had been the consequence of ‘[n]ot having a mother to confide in and look after her in the time of trouble’ and that she had ‘in her destraction (sic) caused her child’s death’.[13] In response to the family’s request, the Department medical superintendent, Dr Charles Bruce, sent a report to the Scottish Office conveying his expert opinion as to the mental state and custodial prospects of Page. Although noting that Page was cognizant of the enormity of her offence and had ‘shown herself to be amenable to discipline and industrious to a moderate extent’, Bruce advised against her release into the care of her family. In his March 1931 report, Bruce now diagnosed Page as ‘emotionally weak’ and ‘a girl of rather low intelligence, whose moral sense is weak. It would be difficult to classify her as moral imbecile, but she could rather be regarded as an abnormal type amounting to the higher grade ranks of mental defection.’[14]

As Stephen Watson’s work has shown, the prison environment provided particularly ample opportunity for medical officers, like Bruce, to observe and assess the history, conduct and behaviour of inmates, while under sustained periods of institutional discipline and supervision.[15] From the latter decades of the  nineteenth century onwards, such practitioners had established themselves as ‘experts’ in the detection of mental deficiency, especially cases of suspected ‘moral imbecility’. A nebulous and vague term, ‘moral imbecility’ was applied to individuals whose moral sense and judgement was considered lacking, often evidenced by heinous or persistent criminal offending and resistance to regimes of prison reform and discipline.[16] We see this process of pathologisation occurring in the Page case, in which Bruce argued that her perceived low intelligence, violent criminal history and ‘weak’ moral sense made her a less than ideal candidate for conditional liberation.

Bruce was also concerned about the environment Page would return to and the impact this might have on her ‘continued good behaviour’. While her brother was evidently keen for her return, her father, George Page senior, was in a poor personal and financial position by March 1931. Not only was he financially struggling as an ‘undischarged bankrupt’, but he was also battling with the fallout from his daughter’s crime. Bruce noted that Page senior regarded himself as ‘an object of scorn to the neighbours because of his daughter’s lapse.’[17] Alternate release into the care of Page’s aunt in London was also considered. However, both Bruce and Dr Robert Alexander Fleming (former President of the Royal College of Physicians in Edinburgh and Medical Adviser to the Department) were concerned about Elizabeth Page’s alleged sexual propensities. Throughout March and April 1931, references were made for the first time in the files to Page’s alleged ‘sexual weaknesses and her dislike of hard work’.[18] In a short, but particularly damning extract of her case, Fleming concluded ‘a very unsatisfactory case. She appears to be a marked sexual degenerate and I do not recommend any action as regards conditional liberation at present.’[19] While it is unclear upon what basis Bruce and Fleming made their assessments of Page’s sexual dissipation (or what the nature of this conduct actually amounted to), it was noted in a subsequent medical report that Page’s aunt was mother to five children, including three sons, the eldest of which was twenty-years-old.[20] One can surmise that doctors were concerned that Page’s purported sexual impropriety might have a corrupting influence on her aunt’s children and lead, in the worst case, to another illegitimate pregnancy and the repetition of the circumstances leading to her previous offending. Consequently, George Page junior’s request for his sister’s release was formally denied on 24 April 1931.

Photograph of Doctor Robert Alexander Fleming. Credit: Public Domain.

It is also probable that broader eugenic concerns over racial fitness and degeneracy shaped the medical opinions voiced by Bruce and Fleming. In a time in which population decline and race had become subjects of national (and international) concern, the inter-war medical profession took an active interest in barriers to discourage the ‘mentally defective’ or those of ‘inferior’ or ‘bad stock’ from having children. In Scotland, such concerns were notably voiced by psychiatrist David K. Henderson, who in a 1934 address to the Medico-Chirurgical Society in Edinburgh urged the profession to:

take stock of our position and appreciate the responsibility which devolves on us medically as the safeguarders of the health of the nation. It is our duty to encourage the growth and development of healthy families, while at the same time approving of the restriction of vitiated stock by segregation, sterilisation, or contraception.[21]

Although conjecture, the reports and correspondence of Bruce and Fleming suggest that these doctors shared Henderson’s dark and prejudicial racialised outlook. In diagnosing Page as a ‘high-grade mental defective’ who was also a ‘marked sexual degenerate’ their medical opinion justified her ongoing segregation and restriction to the Department, while also expediently serving the interests of state officials who were reluctant to consider release. While the language and attitudes voiced by these medical practitioners may seem perplexing and abhorrent to us today, both doctors likely saw themselves as tangibly safeguarding ‘the health of the nation’ amidst a backdrop of heightened anxiety over its future.

Nevertheless, in June 1934, typed correspondence between the Secretary of the Prison Department for Scotland and medical officers, suggests that Page’s continued incarceration presented an issue.  Proposals were made to transfer her to the care of institutions for mental defectives (in Larbert and Kirkintilloch) or an asylum in Cupar. However, low institutional capacity and questions over her suitability for custody in an ordinary asylum as a ‘sane’ woman, proved stumbling blocks for officials. Despite concerns about the potential dangers, Bruce suggested that the conditional liberation of Page to her aunt in London was the only feasible solution for her future supervision and care.[22] Following continued positive reports of her ‘placid’ mental state[23], prison officials raised the question of conditional liberation with the Lord Advocate’s Department in October 1934.[24]  Prosecutors were revealed to be amenable to Page’s conditional liberation ‘if due safeguards [could]… be devised to protect the woman from her own sexual proclivities.’[25] Consequently, a condition was inserted into the order for her conditional liberation that authorities were to be notified by Page’s guardians should she become (or be suspected of being) pregnant.[26]

Elizabeth Page was conditionally liberated into the care of her aunt, uncle and Chelsea doctor, D. Duncan Craig, on 7 November 1934. Two years later, in November 1936, her final prison records indicate that she had found some modicum of independence and normality beyond the shadows of the Department, having gained employment as a live-in domestic servant in London. Although still closely monitored by authorities, Page was able to accompany her employers on their holidays to the seaside and stay in their home, rather than reside permanently with her uncle and aunt. Moreover, the monthly reports of her guardians had reduced to quarterly reports, a development that Bruce noted to be ‘in the interests of the patient by both her uncle and Dr Craig, who considered that she should have some responsibility of her freedom.’ [27] 

Page’s story, as revealed through her prison files, ends at this point. Nevertheless, the case remains unsettling, and many questions remain. The diagnostic somersaults performed by medical experts that led Elizabeth Page to be variously labelled as ‘temporarily insane’, ‘sane’ and then finally, a ‘high grade mental defective’, are disturbing, and powerfully underscore how ideological and pragmatic factors shaped diagnosis and practice in Scottish forensic psychiatry during the 1920s and 1930s. The extent to which Page’s five-year incarceration in Perth Criminal Lunatic Department was driven by expediency on the part of officials or the ideological beliefs of her medical guardians, as opposed to the interests of Page and her loved ones, remains speculative. Indeed, the case raises, though does not resolve, important issues around balancing the rights and liberties of mentally ill patients (and their families) with those of the public and state, especially in a time in which deviant sexualities and abnormal mental states were complexly entangled in broader anxieties over race, national progress and civilization.

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ENDNOTES

[1]‘Strathmiglo Child Murder Charge’, Dundee Advertiser, 7 November 1929 in Criminal Lunatics Files: Elizabeth Cam Birrel Page, 1929 – 1934, National Records of Scotland, HH18/143, n.p. (no page number given).

[2] The testimony of George Page, senior, quoted in Ibid.

[3]‘Strathmiglo Child Murder Charge’ in HH18/143.

[4] Ibid.

[5] ‘Girl Mother Acquitted’, The Scotsman, 7 November 1929, p. 7.

[6] Ibid.

[7] The HH18 series of ‘Criminal Lunatic Files’ covers 1853 – 1964. It is not the only series of CLD patient files. For example, the HH17 series ‘Criminal Lunatic (Perth) Records’ covers a comparable period, 1867 – 1946. Due to data protection laws, the accompanying investigation and trial records of the Page case (ie. JC26 & AD15 series) are not open.

[8] ‘Letter from John Campbell to the Secretary of State’, 15 November 1929 in HH18/143.

[9] ‘Extract of the Verdict Against Elizabeth Cam Birrel Page as taken by Alexander Rae, Circuit Clerk of Justiciary’, 6 November 1929 in HH18/143.

[10] ‘Insane Prisoners – Admission: Elizabeth Cam Birrel Page’, 7 November 1929 in HH18/143.

[11] For an excellent study of the conditional liberation process in relation to women charged with child murder held in Perth CLD, see: Jonathan Andrews, 'The Boundaries of Her Majesty's Pleasure: Discharging Child-Murderers from Broadmoor and Perth Criminal Lunatic Department, c. 1860-1920', in Mark Jackson (ed.), Infanticide: Historical Perspectives on Child Murder and Concealment, 1550-2000, Aldershot & Burlington, Ashgate, 2002, pp. 216-248. Another invaluable exploration of cases drawn from the Forfarshire and Fife areas between 1841 – 1910 is: Morag Allan Campbell, 'This distressing malady': Childbirth and Mental Illness in Scotland, 1820-1930, Unpublished PhD Thesis, University of St Andrews, 2020, pp. 223-267 especially.

[12] Minute correspondence of ‘Mr Duke’, 4 December 1929 in HH18/143.

[13] Letter from George Page junior, to E M Urquhart’, 3 March 1931 in HH18/143. Urquhart appears to be a Dunfermline solicitor that Page junior, engaged to take up his sister’s case.

[14] ‘Medical Report of C. D. Bruce as to Elizabeth Cam Birrel Page,’ 12 March 1931 in HH18/143.

[15] Stephen Watson, 'Malingerers, the 'Weakminded' Criminal and the 'Moral Imbecile': How the English prison Medical Officer Became an Expert in Mental Deficiency, 1880-1930', in Michael Clark and Catherine Crawford (eds), Legal Medicine in History, Cambridge, New York & Melbourne, Cambridge University Press, 1994, pp. 223-241.

[16] Ibid, pp. 223, 232-233.

[17] ‘Medical Report of C. D. Bruce as to Elizabeth Cam Birrel Page,’ 12 March 1931 in HH18/143.

[18] Ibid.

[19] ‘Extract of a Report by Robert A. Fleming to John Lamb’, 15 April 1931 in HH18/143.

[20] ‘Medical Report of C. D. Bruce as to Elizabeth Cam Birrel Page,’ 25 March 1931 in HH18/143.

[21] D. K. Henderson, 'Psychiatry and Race Betterment', Edinburgh Medical Journal, vol. 41, no. 8, 1934, p. 116.

[22] ‘Letter from C.D. Bruce to J Fulton’, 19 June 1934 in HH18/143.

[23] ‘Letter from C.D. Bruce to W Muir’, 18 September 1934 in HH18/143.

[24] ‘First to L.A.’s Dept for any…’, 2 October 1934, Untitled Minute II in HH18/143.

[25] ‘CC think this woman might’, 5 October 1934, Untitled Minute Signed ‘MMC’ in HH18/143.

[26] ‘Letter from the Secretary of the Prisons Department for Scotland to John Lamb’, 29 September 1934 in HH18/143.

[27] ‘Extract of a Report by C.D. Bruce as to Elizabeth Cam Birrel Page’, 26 March 1936 in HH18/20