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University of Warwick, 13-14 April 2023.


On 13-14 April 2023, I organised a two-day workshop at the University of Warwick on ‘Women and Mental Illness in Post-War Britain’, with Professor Hilary Marland and the support of our Centre for the History of Medicine Coordinator, Keri Husband. The workshop was kindly supported by the Wellcome Trust, Warwick’s Centre for the History of Medicine and the University of Warwick’s Global Research Priority, Health. The aims of our workshop were to bring together scholars from different career stages, universities, projects and disciplines to exchange ongoing research on women's mental illness in post-war Britain and explore new subject matter, approaches, issues and ethical considerations in the field of women’s mental health history. The workshop focused largely on motherhood and mental illness in connection with our Wellcome-funded project ‘The Last Taboo of Motherhood? Postnatal Mental Disorders in Twentieth Century Britain’. Other interconnected and novel histories were also shared, including research on asylums (Dr Louise Hide) and orthorexia and clean eating in the twenty-first century (Dr Louise Morgan). The papers also addressed the issues of using new kinds of sources and the ethics of working with sensitive materials.

Day One

Panel One: Gender and Mental Health On the first day, after a brief introduction where everyone explained their synergies with the workshop, our first panel explored ‘Gender and Mental Health’. Dr Fred Cooper (University of Exeter) examined women’s mental health through his paper ‘Formidable Discontents: Loneliness, Gender, and Feminism in Post-war Britain’, which focused on the 1950s. Building on the work of Penny Tinkler, Martin Moore and Eleanor Wilkinson, Cooper shared his ongoing research, including experiences of urban and suburban living for housewives. Cooper used an impressive range of visual sources to illustrate the changing tensions and issues regarding privacy, class, companionship and attempts to rectify the decline in neighbourly communities and support networks to resolve loneliness.

Next, Professor Tracey Loughran (University of Essex) spoke about ‘“Ordinary” Unhappiness and Alienation in Women’s Life Stories, c. 1960-1990’. Loughran is the PI of the Wellcome-funded ‘Body, Self and Family: Women's Psychological, Emotional and Bodily Health in Britain, c. 1960-1990' project, which created an intersectional history of gender, body and the self from the bottom-up rather than the top-down. She highlighted the critical issue of normalising unhappiness and how “ordinary” narratives go unnoticed and remain under-researched as they do not stand out during interviews or in the archive. Loughran suggested that we revisit our sources and subjects, and reflectively put ourselves in the interviewees’ shoes (i.e., how do we use humour and distractions to minimise our own unhappiness in everyday discussions?) to become more conscious and better researchers.

Credit: A woman raising her hands to her face in despair. Watercolour by M. Bishop, 1970. Wellcome Collection.

Panel Two: Student Mental Health in the 1960s.

The second panel explored ‘Student Mental Health in the 1960s’. Dr Sarah Crook (Swansea University) presented a remarkable paper, ‘Contested Spaces: Women Undergraduates and Mental Illness in Post-war Britain’. She illustrated how the medical experts working within some British universities were quick to attribute mental health issues that arose among female undergraduates to their family lives, relationships, and personal issues rather than consider the tertiary environment – or ‘Contested Spaces’ – that they were newly experiencing. Crook, positively concluded, however, that women were highly influential in both shaping and improving universities’ mental health provision from the 1960s onwards. I (University of Warwick) then illustrated in my paper on ‘Mental Health, Marriage, Motherhood and Education, c.1960-1975’ how women had to “drop in and out” of their marriages, childrearing duties, education and work – and in turn prioritised or ignored their mental health issues – to survive a significant culture change in expectations by the early 1960s. Feminist literature, like The Myth of Superwoman (1975), has exposed the challenges of needing to be a ‘perfect’ housewife and ‘the new career woman who could have it all’ by the early 1970s. I argued that these pressures also existed in the previous decades.

Credit: A woman threatened by red clouds and winds. Watercolour by M. Bishop, 1969. Wellcome Collection.

Panel Three: Chronic Illness and Mental Health

The third and final panel of the day focused on ‘Chronic Illness and Mental Health’. Dr Andrew Burchell (University of Warwick) shared his fascinating research undertaken with Professor Mathew Thomson in ‘Narrating Chronicity: Biographical Voices, Gender and Illness from the Mass Observation Project Archive’, focusing on mental health narratives from the Mass Observation Project. This constituted part of the Wellcome-funded Cultural History of the NHS Project. Burchell explained how we could access the narratives in the archive for our own research. He also revealed how they can speak back to their readers, both challenging and disrupting our attempts to find historical patterns in everyday life and health matters. Dr Hannah Elizabeth (London School of Hygiene and Tropical Medicine and the University of Edinburgh) then shared an extraordinarily moving and vital paper, ‘Recovering Experiences of HIV-affected Pregnancy in Edinburgh’. The paper is part of Elizabeth’s broader Wellcome-funded project, ‘What’s love got to do with it? Building and maintaining HIV-affected families through love, care, and activism in Edinburgh 1981-2016’. In their paper, Elizabeth used memoirs, oral histories, counselling manuals, training material and print press coverage to expose problematic cases and the discrimination associated with HIV diagnosis throughout pregnancy and at birth. They also suggested ways to sensitively re-tell these narratives without stripping people's agency.

Credit: A woman falling headlong into a red abyss. Watercolour by M. Bishop, 1959. Wellcome Collection.

Day Two

Panel Four: Mental Health and Institutions of Help and Harm The opening panel for the second day explored the theme of ‘Mental Health and Institutions of Help and Harm’. Dr Louise Hide's (Birkbeck, University of London) project, ‘Hiding in Plain Sight: Cultures of Harm in Residential Institutions for Long-term Adult Care, Britain 1945-1980s’ is also Wellcome-funded. Hide’s reflective paper considered how asylum patients of the 1960s and 1970s were unethically shown in television documentaries when the medium became popular. In her words, historical research on these sources then ‘objectifying[ly]’ turns the ‘medical gaze to the historian’s gaze without their [the patients] consent’. She explained how this can also be done through the internet and through social media in a world of endless channels of dissemination. Hide then suggested ways to become more responsible researchers and think carefully about how people could unethically use and circulate our own research outputs and ways to avoid it. Panel Five: Confinement, Motherhood and Mental Health

Our fifth panel, ‘Confinement, Motherhood and Mental Health’, started with our project PI Professor Hilary Marland’s (University of Warwick) paper on ‘Motherhood, Guilt and Mental Illness in Post-war Britain’. Marland focused on the setting up of Mother and Baby Units (MBUs) after the 1950s and the involvement of the National Childbirth Trust (NCT) in promoting the extension of support and treatment to mothers experiencing postnatal mental illness, highlighting the tensions between the care of the mother and concerns about how the mother’s mental illness might hinder bonding and the infant’s development. Marland's paper also showed how the narratives of NCT mothers reflected upon similar tensions. For her paper on ‘Confined Motherhood in Pandemic-Era Postpartum Psychosis Narratives’, Georgia Poplett (University of Durham) then gave an energised paper on a gothic horror novel The Upstairs House (2021) and film The Babadook (2014). The film is based on a single mother who battles with her son's fear of a monster in the house, but soon discovers the sinister presence around herself. As an interdisciplinary researcher (Creative Writing and Medical Humanities), Poplett addressed the ethics and considerations of using testimonies to write fictional representations of postpartum psychosis. I particularly liked the metaphor of the Babadook confined to the basement, symbolising people’s dormant but ever-present mental health issues.

Credit: An image from the book in "The Babadook," illustrated by Alex Juhasz.

Panel Six: Mental Health in the Twenty-first Century Our final panel ‘Mental Health in the Twenty-first Century’ brought us to present day issues in mental health research. Dr Louise Morgan's (University of Warwick) novel paper, ‘Orthorexia and Clean Eating in Twenty-First Century Britain’, grounded in the broader history of eating disorders, discussed orthorexia's origins and ‘genderless[-ness]’ in relation to clean eating. The term 'orthorexia' was coined in 1998 and refers to an obsession with 'healthy' eating. When considering women’s prevailing obsession with body size and dieting particularly since the post-war period, orthorexia is a topic of monumental significance. Morgan illustrated how social media influencers can reach broader audiences and might hold more authority than medical professionals in ‘clean eating’ debates. And finally, Charli Colegate (University of Sheffield) presented her research on ‘Positionality and Ethical Questions in a Qualitative Study of the Reproductive-related Experiences of Women with a History of Severe Mental Illness’. As a sociologist, Colegate valuably showed us historians how to conduct more fruitful interviews by explaining to interviewees the reason behind our interest in mental health research. By disclosing this information, the relationship between interviewer and interviewee is more equal. Like Loughran and Hide, she offered another method of deploying our personal experiences and positionality as researchers in our writing to improve our practice. She also reflected on the motives behind people agreeing to be interviewed. Finally, she addressed the differences in communication based on the different modes of interview, from phone and video calls to in-person interviews.

Credit: A woman dressed in ochre lies prostrate on a purple ground burying her face in her hands. Watercolour by M. Bishop, 1965. Wellcome Collection.

Concluding Roundtable Discussion

The workshop concluded with a roundtable discussion, which returned to the questions of sources, ethics and care in the context of our historical subjects, interviewees and our own positionality as researchers. Building on Dr Ute Oswald’s (University of Warwick) question on the first day, we discussed the pros (e.g., safety) and cons (e.g., agency-stripping) behind anonymising narratives and returned to the issue of how the expanding opportunities for dissemination, including public engagement, might risk the integrity of our research and the contributions of our historical subjects and interviewees. Dr Jade French (University of Loughborough) noted the abundance of sources we can work with – including more novel social media sources, as Morgan had illustrated in her paper – and the difficult decision-making behind choosing which work best for mental health research. We also spoke about ethical approval procedures at universities, the timing of applications as our projects unfold and develop, and how university processes might focus largely on legal issues. We discussed how to offer better protection for the subjects we are historicising through anonymity, as well as safeguarding our own wellbeing when working on challenging subjects. Hide and another attendee, Dr Jessica Hamett (University of Bristol) also spoke about the Challenging Research Network, and the regular online seminars which provide support and reflective conversations for researchers working in challenging areas. Although the workshop roundtable may have raised more questions than answers, we now have a stronger network of researchers to consider and better resolve issues surrounding mental health research.



















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On 23 February 1928, Northern Irish obstetrician and gynaecologist, Dr Anne Louise McIlroy, gave an address to members of the British Medico-Legal Society.[1] Among the varied audience were men and women of the medical profession, barristers, judges, criminologists, psychiatrists and politicians, who collectively shared an interest in issues pertaining to law and medicine. McIlroy used her short paper, entitled ‘The Influence of Parturition Upon Insanity and Crime’, to argue that the law of infanticide was in ‘an archaic state’ and ‘require[d] further amelioration’.[2] As a doctor who practised, taught, researched and campaigned on women’s health issues, especially the provision of maternity services and improving the experience of childbirth for mothers, McIlroy’s paper covered a subject close to her heart. Moreover, her criticism formed part of a broader chorus of voices being raised against the provisions of the Infanticide Act 1922 in inter-war Britain. In this blog, I provide a concise overview of some of the key criticisms of the Act, highlighting the divergent views within the British medico-legal community toward the law, maternal mental illness and child killing. The lack of consensus over the Act, whether it should be reformed and how this could be achieved, became a central focus of the meeting. Through this debate, historians are also offered insight into changes taking place within contemporary psychiatric thinking which called into question the long-standing acceptance by the medical profession of the existence of distinct reproductive insanities in women.


As discussed in my previous blog, the Infanticide Act 1922 established that a woman could be found guilty of the crime of infanticide if the balance of her mind was disturbed at the time of killing her ‘newly born’ child. Prior to the passage of this Act, infanticidal women were prosecuted for murder, and, if found guilty, sentenced to death. [3] Practically, such women were never executed. Under the new law, the crime of infanticide punished women as if they had been guilty of manslaughter, rather than murder. When the first prosecution brought under the new legislation was heard at Lincolnshire assizes, the presiding judge had been quick to laud the legislation as ‘a wise and humane piece of legislation’ that made it unnecessary ‘to put a girl on trial for murder’. Newspapers had also reported favourably on its impact, with the Aberdeen Press & Journal viewing the Infanticide Act as ‘only a single illustration of the remarkable increase in the attention which Parliament in recent years has devoted to the woman’s point of view’.[4] The feminist periodical The Vote was less positive in its assessment of the Infanticide Act, arguing that the burden of punishment for child murder still fell disproportionately on accused women. In a retort to Justice Lush’s positive assessment of the outcome of the Emma Temple case, the article remarked, ‘We should like to know why Mr Justice Lush has nothing to say about the responsibility of the father in such a case?’ and argued that the father should also appear in court and be questioned on how he would provide for the infant.[5]


Criticisms were heaped on the legislation from all quarters with each passing year. Judges and lawyers argued that it was unclear who had the jurisdiction to bring in a bill for infanticide and that the Act was badly drafted.[6] Moreover, successive criminal cases problematised the once seemingly ‘humane’ provisions of the Act. Mary O’Donoghue was found guilty of the murder of her illegitimate four-week-old son following her trial on 13 October 1927.[7] Although her capital sentence was commuted, O’Donoghue appealed her conviction on the grounds that the trial judge should have advised the jury that they had the power to return a verdict of infanticide. Following consideration by the Court of Criminal Appeal three weeks later, O’Donoghue’s appeal was quashed. Significantly, the decision seemed to establish that for a mother to be charged with the infanticide of her ‘newly born’ child, the infant could not be older than a calendar month at the time of its death. While the change in law had offered protection toward women who killed children less than a month old (and so informally defined as ‘newly born’) mothers who fatally harmed older children were still tried for murder and sentenced to death. The ‘black cap farce’ was a shorthand used in the press to describe the courtroom spectacle of sentencing such women to execution, though they would always be reprieved. The phrase also embodied disquiet with the stigma such women acquired through the public spectacle of being labelled a ‘murderess’ in the courtroom. Although the Infanticide Act had gone some way to addressing this issue, the exclusion of mothers like O’Donoghue from its provisions, drew increasing criticism throughout the 1920s and 1930s.



A. Louise McIlroy
Dame Ann Louise McIlroy, 1919. Credit: Public Domain

A little over three months since the outcome of the O’Donoghue trial, McIlroy referenced the decision in her address before the Medico-Legal Society. For her, the case threw into stark light the problematic language of the Infanticide Act, particularly the lack of clarity over what age limit should be applied to a ‘newly born’ infant, and whether it exceeded a month or even a few weeks.[8] McIlroy also explained that ‘In medicine the definition of a newly born child is somewhat vague. Obstetricians look upon the newly born or neonatal infant as one less than ten days old. But this period is frequently extended to one month for purposes of mortality statistics and diseases.’[9] In addition to clarification on the term ‘newly born’, McIlroy argued that the Infanticide Act and the broader law on murder failed to offer adequate protection to mentally disturbed mothers and was thus ‘illogical and unjust’.[10] In particular, she perceived that the existing law was more sympathetic to infanticidal women who killed their children ‘in a moment of mental anguish’ despite knowing their actions were wrong, than toward mothers who killed while suffering from diagnosed puerperal insanity and who were consequently tarnished with the label of murderess through a verdict that adjudged them ‘Guilty but insane’.[11] McIlroy also asserted that mothers who killed their children while labouring under puerperal or other forms of reproductive insanity, needed to be marked out as a special group of offender and treated differently by the criminal law, for:

Motherhood is a necessity for the race. It is the factor of motherhood that makes the woman insane and causes her when suffering from a disease due to motherhood to destroy her offspring. There is a marked difference between a murder committed by a person suffering from general paralysis or even paranoia, and one committed by a mother in the delirium of childbirth or exhausted by nursing.[12]

Influenced by eugenic thinking, concerns over citizenship and the fitness of the inter-war population, McIlroy reminded her audience that motherhood was not simply a private, domestic activity, but was instead central to the agenda and future success of the British state. After all: ‘Motherhood is a sacred and patriotic service, and no woman should run the risk of being branded as a murderess because she happens to fall a victim to one of the diseases incident to pregnancy.’[13]


McIlroy’s address sparked a varied response, including some hostile reactions.



Travers Humphrey
Judge & barrister Travers Humphreys, 1928. Credit: From the cover of 'Criminal Days' by Sir Travers Humphreys, Hodder & Stoughton (1946)

For those in sympathy, like Justice Travers Humphreys, the 1922 Act was problematic in failing to offer a definition of the term ‘newly born’.[14] Moreover, its existence would have been unnecessary he argued, were it not for the spectre of the ‘black cap farce’ that left ‘a judge assuming the black cap and sentencing to death a person who, as he and everyone else knew, was not in the l[e]ast danger of being hanged and who would probably be released in a few weeks.’[15] Doctor F. J. McCann suggested that ideally the Act should only apply to those who killed neonates (children less than 24 hours old), as the existing provisions of the insanity defence could be deployed for women accused of the murder of older children while mentally unsound.[16] Another doctor, M. I. Finucane disagreed. He had given expert evidence in a recent criminal case and felt that the Act should extend to women who killed during the puerperium, six weeks after birth. This time limit, Finucane argued, would encompass not only the physical and psychological changes associated with delivery, but also cover the broader period in which women were at higher risk of suffering from a disturbed mental state.[17] While for Lord Baron Riddell, former solicitor and director of the popular and sensationalist Sunday paper News of the World, the problematic verdict of ‘Guilty, but insane’ should be avoided altogether when mothers killed while mentally unstable and be replaced with a verdict of ‘Infanticide’.[18]


Psychiatrists and criminologists, like Hubert Bond and William Norwood East, had more profound problems with McIlroy’s assertions and the existing Act. For Bond, whose experience as an asylum medical superintendent put him in proximity with the mentally ill, dominant psychiatric thinking found little evidence to suggest that disorders linked to pregnancy and reproduction – such as puerperal or lactational insanity – were discrete psychiatric illnesses at all. While conceding that mental illness may emerge at times of physical and psychological crisis in the reproductive lives of many women, Bond could not sustain the view that such insanities existed distinctly in their own right, remarking: ‘there is no mental disorder (psychosis) which, by its mental symptoms and in the absence of knowledge otherwise gained can be recognized and diagnosed as due to childbearing.’[19] Norwood East, whose research focused on criminality and mental illness amongst men, went further still. East challenged the perceived exceptionalism of child killing as a gendered offence that required distinctive treatment of women under law, noting that:

Fatherhood equally with motherhood was a necessity for the race, and fathers were sometimes tried for killing their children and found insane. One of the contributing factors in such a case was the stress of providing for their families, and it would be difficult for juries to draw a distinction between motherhood and fatherhood.[20]


William Norwood East
Sir William Norwood East. Bromide print by Walter Stoneman, 24 July 1947. Credit: © National Portrait Gallery, London. Reproduced by permission with an Academic Licence.

McIlroy’s address to the Medico-Legal society was certainly not the first, nor would it be the last attempt of a medical practitioner to publicly deliberate on the administration and future of the Infanticide Act 1922. The debate that followed her address, highlights both the lack of consensus within the medico-legal community over the existence of distinct forms of reproductive insanity and the wider issue of whether women who killed their children should be treated differently under the law. In a period in which a new generation of British psychiatrists were calling into question the old Victorian diagnoses of puerperal insanity and allied conditions, the record of the Medico-Legal society meeting in February 1928, captures a moment of tension and change in the history of psychiatry, as well as from within the medical profession itself. The divergent views the medico-legal community expressed toward maternal child killing and the role mental illness may (or may not) have occupied in these cases, partly explains why reform of the Infanticide Act was so slow in coming. Another decade would pass after McIlroy gave her contentious paper before the law would finally be repealed and replaced by the Infanticide Act 1938, which is still on the statute books today.


 

ENDNOTES

[1] A. Louise McIlroy, 'The Influence of Parturition Upon Insanity and Crime', Transactions of the Medico-Legal Society, vol. 22 (1927-1928), p. 53. [2] Ibid., p.61. [3] Infanticide Act 1922, c. 18. [4] 'Laws "For Women"', Aberdeen Press & Journal, 2 November 1922, p. 4. [5] 'New Infanticide Act', The Vote, 3 November 1922, p. 4. [6] See for example: 'The Infanticide Act: Recorder On A "Badly Drafted" Measure', Gloucester Journal, 17 January 1925, p. 9; 'Murder Charge in Gloucestershire: Baby's Body In A Box', Cheltenham Chronicle, 23 May 1925, p. 6; 'Killing Newly Born Children. Judge and Grand Jury. Women Wrongly Accused of Infanticide', Portsmouth Evening News, 29 October 1929, p. 9. [7] See for example: 'What Is A "Newly Born" Child? Point Argued in Court of Criminal Appeal', Gloucester Citizen, 7 November 1927, p. 6. [8] McIlroy, 'The Influence of Parturition Upon Insanity and Crime', p. 56. [9] Ibid. [10] Ibid., p.58. [11] Ibid., pp.57-58. [12] Ibid., p.61. [13] Ibid., p.59. For an exploration of the provision of maternity services in twentieth century Britain and the emphasis on the needs of the state, see: Fabiola Creed and Hilary Marland, 'Improving Maternity Care through Women’s Voices: The Women’s Health Strategy Continues a Long Process of Advocacy', History & Policy, 15 February 2023, <https://www.historyandpolicy.org/policy-papers/papers/improving-maternity-care-through-womens-voices-the-womens-health-strategy-continues-a-long-process-of-advocacy>,(accessed 25 April 2023). [14] Ibid., p.63. [15] Mr Justice Humphreys, quoted in ibid. [16] Ibid., pp.68-69. [17] Dr M. I. Finucane quoted in ibid., p.70. [18] Ibid. [19] Dr Hubert Bond quoted in ibid., p.64. [20] Norwood East quoted in ibid., p.72.

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In February 1904, Florence H. was admitted to Claybury Asylum with a diagnosis of acute puerperal mania.[1] Aged 23 and a resident of Islington in north London, the birth of her first child was given as the ‘exciting cause’ of her illness. The entry in the asylum casebook described how Florence ‘had tried to get at baby’ and to throw the three-week-old child out of the window. She was raving, restless and noisy and was taken to the asylum on a stretcher under restraint. ‘She chatters and sings incoherently’, it was noted in her case history. The diagnosis of puerperal insanity was confirmed by Medical Superintendent, Dr Robert Jones, a week later. Florence was initially kept in a padded room where she was said to have been ‘constantly moving about’ and to ‘turn somersaults’. She was noted to be in poor health, was coaxed to eat by the nurses and thereafter ‘took nourishment abundantly’. After ten months in Claybury, Florence was reportedly much better, and in February 1905, a year after her admission, she was discharged recovered to a local workhouse.[2]


Over the last few months, I have been exploring the early twentieth-century casebooks of two major London lunatic asylums and the admission of patients experiencing mental disorders attributed to pregnancy, childbirth and breastfeeding. The first, Colney Hatch Asylum in North-East London, opened in 1851 and served the most deprived and densely populated areas of London’s East End. The second, Claybury Asylum in Woodford Bridge, Essex, was established over four decades later in 1893, as London’s fifth County Council asylum. By the early twentieth century, London County Council had built up one of the largest asylum systems in the world, and in 1907 its ten asylums housed over 20,000 patients.

Colney Hatch Lunatic Asylum, Middlesex n.d. Credit: Wellcome Collection.

The records of both institutions present challenges for researchers. Access to archives involving patient records is restricted to casebooks over 100 years old for reasons of both confidentiality and sensitivity, and Claybury has few surviving casebooks for this period. Meanwhile, Colney Hatch has an exceptionally full run of casebooks but a number of these have been closed to researchers due to their extremely fragile state. Nonetheless, these sources provide valuable testimony about how women suffering insanity related to childbearing were diagnosed, their backgrounds and their experiences in the asylum.

Claybury Asylum, Woodford, Essex: a dormitory c.1893[?]. Credit: Wellcome Collection.

Dr Robert Jones, Claybury’s Superintendent, had a special interest in mental breakdown related to childbirth. He published extensively on puerperal insanity in British and American medical journals, declaring in 1902 ‘that gestation is attended with much nervous disturbance in many, and some nervous disturbance in all’.[3] Claybury provided Jones with ample material for his publications. Childbirth was listed as a major cause of mental breakdown, and between 1896 and 1902 259 women were admitted with diagnoses of insanity of pregnancy, confinement or lactation.[4]


Florence H.’s experience cited above is representative of numerous women admitted to Claybury and other London asylums in the early years of the twentieth century. The majority of women suffering puerperal insanity were brought to Claybury within a few weeks of their confinement, and many were discharged relieved or cured within a year of admission. Some were sent home, others removed to the workhouse. While puerperal insanity was often associated with hereditary causes and instances of mental illness in the family, social and economic factors were also deemed significant. Jones also appeared to empathise with the plight of his female patients, highlighting in his published work the stress resulting from overwork, penury and domestic troubles.[5]


In terms of treatment, there was little in the way of medical or pharmaceutical intervention. Though sedatives might be prescribed, attention was primarily devoted to encouraging the women to rest, eat and take on a regular routine. Given the impoverished backgrounds of most patients, many were poorly nourished on admission and were ‘coaxed’ to eat by spoon feeding or use of a feeding tube. Unlike current day treatment, where ideally women keep their babies with them, the infant was usually removed from the mother, and brought to the workhouse or cared for by a family member. Florence’s confinement in a padded room might have been to protect her from harming herself – she was reported to be very excited and badly bruised on admission – and it avoided the use of a strait jacket. It was commonly observed that women experiencing puerperal mania might, like Florence, be in poor physical health yet at the same time exceptionally strong, energetic, and violent. Her threatening behaviour towards her baby was common in such cases, and many women were also believed to be at risk of harming themselves.

Colney Hatch Casebook 1905. Credit: London Metropolitan Archives, H12/CH/B/11/55, Female Casebook June-Nov. 1905.

Colney Hatch Asylum was notable for its admission of large numbers of ‘alien’ patients, particularly after London County Council took the decision to concentrate Jewish patients there in 1872. Colney Hatch introduced special religious and dietary provisions for their Jewish or as they were commonly referred to ‘Hebrew’ patients.[6] Many were recent migrants to London from Eastern Europe, some of whom spoke little or no English, and almost all were impoverished and in poor physical health. Despite efforts to accommodate a growing asylum population that had reached 2,500 by 1900, the institutional experience for inmates was likely to be grim. For women already struggling with the disruptive and alienating consequences of mental illness, daily life on wards, which were reportedly decrepit, gloomy and uncomfortable, must have been frightening.


The medical staff appear to have been responsive to the information given by Jewish family members, particularly if the patients were unable to communicate themselves. Usually, it was husbands who described how childbirth had prompted their wives’ mental breakdown and on occasion this led to a change in diagnosis. When Eva C., ‘Hebrew’, aged 24 and resident in Mile End, was admitted on 15 February 1905, the cause of her insanity was given as ‘a fright’. She was described in the case notes as depressed, melancholic and vacant, yet also liable to be troublesome and ‘spiteful’. She was also refusing to eat. When her husband visited, he explained that she had ‘not been right’ since the birth of her second child five months ago and had been unable to sleep; accordingly, a provisional diagnosis was recorded of ‘melancholia lactational’. Sadly, Eva’s condition worsened, and she died at the end of February, when the cause of death was given as ‘Acute Melancholia or Exhaustion. Natural Causes’.[7] This was an unusual outcome for such cases given their generally good prognosis, though lactational melancholia was regarded as particularly difficult to cure.


Twenty-three-year-old Leah C., also recorded as ‘Hebrew’ and from Mile End, was admitted to Colney Hatch with a diagnosis of puerperal mania on 2 June 1900. The admission notes reported her to be ‘dazed, bewildered and wild’ and her physical health ‘impaired’. On visiting the asylum, her brother-in-law and husband explained that Leah had lost her first baby after a miscarriage; she also had a three-year-old child at home. Several weeks before her last delivery on 22 May, her husband explained that Leah had begun to ‘talk nonsense, saying she would do away with herself’. She initially refused to eat, and her recovery was slow throughout the rest of the year. However, in February 1901, Leah showed significant signs of mental improvement. She was sent out for a trial period with her family and was discharged ‘recovered’ the following month. (Photographed before discharge, it is possible in the image below to see the restraining hand of a nurse keeping Leah still while the photograph was taken.)[8]


Leah C. before discharge. Credit: London Metropolitan Archives, H12/CH/B/11/47, Female Casebook Dec. 1899-Aug. 1900.

These select examples provide some insights into childbirth-related cases of mental illness treated at Colney Hatch and Claybury Asylums in the early twentieth century. Many patients were single mothers, and a future blog will describe their experiences, including, for some of these women, delivery in the asylum. Though admission to an asylum must have been a miserable experience, it provided a route to recovery for many. The women appear to have been well treated on the whole, despite the limitations of overcrowded wards, staffed by overworked doctors and nurses. These cases also provide insights into the hardships experienced by working-class women of London around this time, compounded for many by anxiety about bringing another child into the world. For some the asylum proved to be just that: a place offering shelter, food, care, and respite.


__________________________________________________________________________________


NOTES

[1] I am using early twentieth-century terminology in this blog. At this time the term ‘lunatic asylum’ was still in common usage to describe what after the 1930s were increasingly referred to as ‘mental hospitals’. I have also employed terms such as 'insanity' and 'mental disorder', in frequent usage during this period. [2] Redbridge Central Library, Claybury Asylum Female Casebook Nov. 1903-Aug. 1904, Florence H, admitted 17 Feb. 1904. [3] Robert Jones, ‘Puerperal Insanity’, British Medical Journal, 8 March 1902, 579-86, quote p.579. [4] Ibid. [5] Louise Hide, Gender and Class in English Asylums, 1890-1914 (Houndmills: Palgrave Macmillan, 2014), p.33. [6] Rob Ellis, London and its Asylums, 1888-1914: Politics and Madness (Basingstoke: Palgrave Macmillan, 2020), 212-13, 215; Len Smith, ‘Insanity and Ethnicity: Jews in the Mid-Victorian Lunatic Asylum’, Jewish Culture and History (1998), 1, 27-40, p.34. [7] London Metropolitan Archives (LMA), Colney Hatch Asylum/Friern Hospital, H12/CH/B/11/54, Casebook for Female Patients Admitted Dec. 1904-June 1905, Eva C. admitted 10 Feb. 1905. [8] LMA, H12/CH/B/11/47, Casebook for Female Patients Admitted Dec. 1899-Aug. 1900, Leah C.. admitted 2 June 1900.

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