By: The Project Team
With generous funding from the Wellcome Trust, our project explores the history of maternal mental illness in twentieth-century Britain. It aims to understand the changes that took place in labelling, describing and diagnosing postnatal mental illness across the twentieth century. Moreover, it examines how these changes influenced care and treatment in a variety of institutional medical settings, including early twentieth-century mental hospitals, maternity hospitals, obstetric wards, and after the 1950s mother and baby units. Over the course of the twentieth century, an ever-expanding range of health professionals, including psychiatrists, obstetricians, midwives and health visitors, became involved in the care of women experiencing postnatal mental illness, as did a number of charitable, campaign and grassroots organisations; our project aims to chronicle the changing profile and influence of many of these different groups.
To a large extent our project focuses on postnatal depression (PND) which was described and labelled by psychiatrist Brice Pitt in 1968, though many health professionals and women were aware of this condition before then. It is also by far the most common type of postnatal mental illness and one that continues to affect women in large numbers. We also explore changing responses to puerperal psychosis, which, although rarer in comparison, can be more dangerous and disturbing in its experience and presentation for sufferers and their families.
To compare ideas about postnatal mental illness over time, we will also explore cases from the late Victorian period. Around 1900, many psychiatrists questioned whether conditions associated with childbirth existed as distinct categories of mental illness. Nevertheless, Victorian-era diagnoses of ‘puerperal insanity’, ‘lactational insanity’ and ‘insanity of pregnancy’ continued to hold currency in the twentieth century. We are discovering that criminal prosecutions and medico-legal literature dating to the 1930s and 1940s continued to draw upon these older diagnostic labels to make sense of mothers’ mental states. We are also greatly fascinated by the energetic debates that occurred throughout the twentieth century on the causes of postnatal mental illness, and the ways in which these were attributed to a range of medical, psychiatric, hormonal, and social or cultural factors.
These debates went way beyond medical literature. We are discovering that organisations, such as the National Childbirth Trust (NCT), provided support and advice to women experiencing postnatal mental illness from the 1960s onwards. The NCT outlined a wide range of potential causes – amongst them a lack of support networks, poor housing, poverty, exhaustion and loss of employment outside the home, which left new mothers feeling isolated and frustrated. One of the organisation’s most powerful contentions, however, was that postnatal mental illness might be a direct result of the shifting place of birth from home to hospital, which women experienced as a loss of control and agency, leading to births that had been traumatic and lonely.
The twentieth century was marked by huge changes that shaped women’s experiences of childbirth and motherhood. These included fundamental alterations in the delivery of childbirth services, notably the move from home to hospital, changing expectations about pain management, and the stepping-up of technological interventions in deliveries. Other significant changes also took place in women’s lives, as their status changed in the home, workplace and in relation to their reproductive autonomy. Our project also considers how far women’s lives were shaped by the rise of feminism, changing family structures and dynamics, and new ideals and practices of parenting. We also examine the impact of broader changes in British society, such as migration, two world wars, demographic change, shifting employment patterns, and alterations in the status and experience of women as subjects under the law. While white middle-class women tend to feature most strongly in narrative accounts and in organisational literature, we aspire to examine the experiences of a wide range of British mothers in terms of race and ethnicity, social class, disability and sexuality.
Key to our project is the exploration of women’s own experiences of postnatal mental illness, drawing on a large body of narrative accounts, such as letters, memoirs, magazines, newspaper articles, legal depositions and oral history collections. We aim to understand why women wrote about their experiences and to assess their agency, as ‘experts by experience’, in shaping public and professional understanding of maternal mental illness. The project team also examine the role of the media – from the press and magazines to radio and TV – in offering information and support to women experiencing postnatal mental illness and in shaping public perceptions.
We are discovering, for example, that the BBC’s Woman’s Hour broadcasted numerous episodes on postnatal depression, and was already discussing ‘post-puerperal depression’ by 1960, a topic it repeatedly returned to for decades to follow, even to this day. Some broadcasts generated a powerful response, including Nemone Lethbridge’s 1973 Play for Today, ‘Baby Blues’. The play triggered both outrage and a plea for support for women experiencing postnatal mental illness through the press. Television ‘clean up’ campaigners, medical experts, and mothers and fathers sent thousands of letters responding to ‘Baby Blues’ for several years after it was broadcast.
In some contexts, the media exacerbated the stigma associated with severe postnatal mental illness. This applied particularly to the small number of women who, while suffering extreme forms of mental disturbance, committed infanticide or attempted to harm their children. Such incidences attracted extensive media attention while also shocking the families and communities closest to the women accused. However, we are also finding that some media accounts could be sympathetic, with press reports suggesting that women suffering from postnatal mental illness were fundamentally ‘good mothers’ whose natural instincts had been drowned out by anxiety, confusion and depression.
In the courtroom, the insanity plea continued to be drawn on by medical experts and witnesses to explain infanticide or child harm. In such cases, a variety of medical practitioners - from local GPs and hospital doctors to prison medical officers and esteemed psychiatrists - drew upon their ‘expertise’ to explain the extreme and violent outbursts of women accused of shocking crimes. Drawing on legal records, medico-legal literature and press reports from English and Scottish cases, this project also seeks to better understand the ways in which a woman’s mental illness was seen as prompting the most extreme actions.
Why ‘taboo’ in the title of our project? The contrast between expectations of motherhood as a time of joy and fulfilment and the anxiety and depression associated with maternal mental illness has not lost its ability to shock. Women might be castigated for their neglect of the home and children, or for their expressions of violence or anger. Throughout the twentieth century, many women suffering from postnatal mental illness were removed to asylums or mental hospitals for treatment and stigmatised because of this. Many women also described a reluctance about revealing their mental distress after childbirth, as it risked disapproval and censure for contravening expectations of ‘good’ motherhood. We are finding that this reluctance was particularly strong among poor or black and Asian women, women who also had poorer access to childbirth services and suffered other health inequalities.
We have aimed here to give a flavour of some of the themes which we will be exploring in the coming months as we carry out our research in archives, libraries and online. Providing historical context and developing our knowledge of how postnatal mental illness was explained, treated and regarded in the past might enable us to better understand how it is responded to today. Future blog postings will provide more insights into our research sources and approaches, as well as expanding on our findings. We invite you to continue to read our blogs, which we will post every month or so along with other news about our project, including our exciting public engagement plans.