Prof. Hilary Marland (Warwick)
'The Protracted Funeral of Puerperal Insanity'? Diagnosis, Heredity and Reproduction in Britain c.1900
During the final quarter of the nineteenth century, doubt began to be cast on the separate existence of one of the most clearly recognised psychiatric entities of the Victorian period: puerperal insanity. After the 1820s puerperal insanity, along with its sister disorders of insanity of pregnancy and lactation, had been recognised as a common cause of mental breakdown in women, a disorder prompted by the strains of reproduction in combination with a range of hereditary, social and biological factors. By around 1900 it appeared to have been eliminated from the psychiatric canon, the coincidence of childbearing and insanity no longer regarded as sufficient to warrant a discrete diagnosis. However, rather than producing taxonomic clarity, the result was diagnostic confusion, and as late as 1935 one psychiatrist was prompted to declare that puerperal insanity was still enjoying its ‘protracted funeral’.
This presentation explores debates around the separate existence of puerperal insanity as other factors also came into play in the latter part of the nineteenth century, notably a shift towards more clinical rather than narrative forms of reporting cases of mental breakdown and the tendency to relate mental disorders connected to childbirth to heredity causes. It will explore the tensions between changing psychiatric definitions and actual practice, as the diagnosis of puerperal insanity continued to be employed in many institutional settings and the courtroom, in some obstetric and psychiatric texts and medical journal articles and case reports. In some asylums, the number of cases attributed to puerperal insanity actually increased towards the end of the century. The presentation also questions how far there was continuity and change in terms of ideas of causality, as alongside heredity doctors continued, well into the early decades of the twentieth century, to hark back to the explanations of ‘the Victorian doctors’ which highlighted the intrinsic risks of reproduction, the challenges of becoming a mother, and the impact of poverty, marital distress and exhaustion in producing insanity in pregnancy and childbirth.
Hilary Marland is Professor of History at the University of Warwick. She is author of Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (2004), Health and Girlhood in Britain 1874-1920 (2013) and with Catherine Cox, Disorder Contained: Mental Breakdown and the Modern Prison in England and Ireland, 1840-1900 (2022). Between 2014 and 2021 she was co-Principal Investigator on a Wellcome Trust funded project on prison medicine in England and Ireland, 1850-2000 and is currently Principal Investigator on a Wellcome Trust Investigator Award, ‘The Last Taboo of Motherhood: Postnatal Mental Disorders in Twentieth-Century Britain’ (2021-24). She was founder and for many years Director of the Centre for the History of Medicine at Warwick and former editor of Social History of Medicine. Her research interests and publications have focused on women, medicine and psychiatry, migration and mental illness, prison medicine, medicine and the household, and the history of childbirth and midwifery.