Madness at Home: The Psychiatrist, the Patient and the Family in England 1820-60 
by Akihito Suzuki.
California, 260 pp., £32.50, March 2006, 0 520 24580 6
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In February 1823, readers of the Times were treated to a detailed account of the goings-on in the home of the third Earl of Portsmouth and his wife of ten years, Mary Anne Hanson. She had for some time been having an affair with William Rowland Alder, a lawyer. The pair abused and mocked Lord Portsmouth, both physically and mentally, even making him a spectator to their fornication. These details came to light through a legal instrument known as a ‘commission in lunacy’, whose roots go back to the 14th century, but which became prominent in the 19th, before fading away after the First World War. It was used mainly by wealthy families intent on demonstrating that one of their members was incapable of managing his affairs. Women, too, were sometimes subjected to commissions in lunacy, but less often, since married women were not held to have property rights that anyone might wish to divest them of. In the Lord Portsmouth case, the purpose was to prove that he had been incapable of managing his own affairs at the time he married Mary Anne, and that the marriage should therefore be dissolved. The story of his having been forced to witness the debauchery was invoked by counsel to show that only a madman could have failed to understand what was taking place in his family home.

Historians of insanity in the 19th century have tended to focus on the rise of the asylum, and there has been less work on the relations between families, doctors and patients. Akihito Suzuki explores the domestic side of the social history of madness, seeing it from the viewpoint of contemporary upper-class families. This is not to say that he forsakes the public realm for the private; rather, he examines the ways in which the two spheres interacted: the family’s dealings with doctors, public authorities and the crowd on the street. Commissions of lunacy were sometimes held in taverns or coffee houses, and were often well attended by the public and extensively reported in the press. Around a dozen of them became major news stories and it was not unknown for the Times to devote an entire issue to a case. Though the commission potentially offered a means to reassert control over family property, it also involved washing dirty linen in public, with the attendant risk that the alleged lunatic might find allies and supporters: it was not unknown for the crowd to intervene in an attempt to frustrate the family’s efforts.

This was a time when domestic virtues – the maintenance of patriarchal authority, but also the affection displayed between husband and wife – were the touchstone by which individuals were judged for their fitness to serve in public life, as demonstrated by the widespread popular agitation in support of Queen Caroline. Public morality was being made to depend on private integrity, and so the private sphere was becoming an object of increased interest and scrutiny. Lord Portsmouth’s mental health was in question because he had undermined the patriarchal foundations of sanity, but also because he was a party in a loveless marriage.

One of the major attractions of the commissions was the behaviour of the lunatics themselves, and the commissioners, as Suzuki remarks, frequently exhibited an ‘unmistakable relish for comedy or psychiatric freak show’. Isabel Sprout was said to believe that ‘she was empress of the whole world, except the East Indies, which was too hot,’ and the commissioner got her to say as much at the outset of the proceedings. But Suzuki argues convincingly that we should not dismiss the commissions as merely providing opportunities for voyeurism, since they empowered ‘lunatics’ as much as disempowering them, providing a space in which they could speak publicly. Thomas Telford Campbell, the son of the poet Thomas Campbell, impressed the jury with the ‘urbanity, coolness and composure’ of his performance in cross-examining witnesses, and persuaded them to reject the medical testimony against him.

There was no shortage of physicians who considered it their duty to act as guardians of property, producing on occasion ‘a remarkable bending of psychiatric decision-making to the practical needs of the financial situation of the family’. Indeed, James Prichard devised the category of ‘moral insanity’ as a diagnosis (an ‘ambiguous modification of insanity’, he called it) expressly tailored to the needs of wealthy families keen to deprive relatives who were troublesome, but not insane by the usual criteria, of their civil rights in order to spare the family from ruin or infamy. One noted alienist, John Haslam, hinted at an affinity between respect for property and sanity, insinuating that a disregard for or neglect of property was evidence of a delusional state. Asked whether miserly habits indicated unsoundness of mind, Haslam replied: ‘If those miserly habits trench on the health or the property of the individual, then I can conceive that his actions are delusions.’

There were some psychiatrists, however, who felt differently. In the opinion of John Conolly, for example, freedom of the individual took priority over protection of the family’s property. ‘Let the practitioner never forget,’ he declared, ‘that he may be the patient’s last and only hope.’ Indeed, Conolly was extraordinarily mistrustful of families, warning of the tricks they might play to unsettle the alleged lunatic and present him in an excited state, giving as an example a wife who abused her husband in front of Conolly until he left the room in exasperation, slamming the door, whereupon she said: ‘You see what a state he is in; he does this twenty times a day; there is no living with him.’ When he interviewed the husband on his own, Conolly was soon convinced of his sanity.

At the same time, many physicians over-reached themselves. Rival teams of doctors argued in court over Edward Davies’s manifest antipathy to his mother and whether it was delusional, one side claiming, as Suzuki has it, that she was ‘a nice mother, full of maternal love’, the other that Davies ‘had good reason to react angrily, implying that the mother was a wicked old hag’. As it turned out, the doctors’ declarations rested entirely on what they’d been told by other family members, not on their own observations; indeed, when cross-examined by the defence, they were unable to produce a single example of Davies’s so-called ‘delusions’. This was one of the cases that proved to be the undoing of the well-known alienist and self-publicist George Man Burrows (who had quite a stock of delusions of his own, among them that he could smell madness and detect a ‘maniacal odour’). He was given a keelhauling in the press for his arrogance and disregard for the liberty of the subject, and the term ‘burrowsed’ was coined to describe those wrongly confined. Burrows maintained that he was the victim of a press conspiracy.

It was equally fanciful to believe the family’s view of things could be entirely dispensed with. Conolly’s recommendations may have been ideologically appealing, but they were quite impractical. The psychiatrist was bound to be dependent to some extent on the family’s account, since they knew the patient best. Far from disenfranchising the lay view, the consolidation of professional psychiatric authority rested on a cautious, but still respectful engagement with the family’s opinion.

Thanks in part to evangelicalism and its strong emphasis on emotional solidarity and regard for the inner life of family members, upper-class families in this period seem to have had their own cultural resources for understanding madness and decoding the psyche. Indeed, through the practice of what Suzuki calls ‘domestic psychiatry’, families may have had an advantage over contemporary alienists, and filled something of a vacuum, at a time when so-called scientific psychiatry was largely silent about the ‘meaning’ of madness.

‘Domestic psychiatry’ encompassed a variety of practices, not all malevolent, though some clearly self-serving. In 1816 Hastings Nathaniel Middleton, a London banker, was informed that his mother had become restless and disturbed in manner, withdrawing into herself, showing no emotion towards those who displayed concern for her, and oscillating between meanness and profligacy in her handling of the family affairs. In the wake of the French Revolution and the Napoleonic Wars, the family business had collapsed, and Middleton, his wife and five children were reduced to living on the income from his wife’s property. Yet it was not so much anxiety over his failure as a banker that precipitated his mother’s decline, Middleton concluded, as his sister’s elopement and the ‘infelicitous consequences’ of her marriage. His mother’s conduct had itself contributed, he also believed, especially her ‘secrecy’ about her financial affairs. ‘She has been acting for years,’ he asserted, ‘in a spider-like capacity, insensibly, but fatally, spinning a web.’

Initially, he proposed bringing his mother to live with him, but he soon thought better of it, and indeed of any suggestion that she might reside anywhere near him: ‘Brighton, should be the last place proposed,’ he informed a correspondent. ‘She would not be there 24 hours, before, busy slander, ever mischievously inclined, would noise throughout the whole town that Mrs Middleton … was under surveillance & incompetent to the management of her own affairs, and thus a stigma would be thrown upon herself and family, and a publicity given to the occurrence which would aggravate our misfortunes.’ His mother would be better placed, he proposed, ‘in a small house … on the sunny side of London, somewhere about Clapham or Stockwell’. Middleton was not alone in this view; some families would go to great lengths to hide an insane relative. The family of George Smith, a wealthy farmer from the Midlands, went so far as to brick up the window of the room in which he was kept (though it was the best room in the house).

A popular instrument, among the aristocracy especially, was a ‘psychiatric arranged marriage’, in which a weak-minded or insane peer was married off to a presentable and controlling older woman. One young aristocrat found himself married to a woman more than twice his age whose duty was to conceal ‘his infirmities from the eye of the world’ and prevent him from ‘exhibiting any of that ungovernable conduct which required medical aid’. The family honour as well as its property had to be safeguarded.

Needless to say, these schemes did not always go according to plan. When Rosa Bagster, allegedly a weak-minded heiress, found herself being drawn into an arranged marriage, she decided to elope with her secret lover (just as her mother had done, in her own rebellious youth), eluding her minders and escaping in a carriage after a tryst at London Zoo, exchanging vows at Gretna Green, and consummating the marriage at an inn near Keswick. To reassert control over the family fortune, her mother initiated a commission in lunacy to nullify the marriage on the grounds of Rosa’s ‘unsoundness of mind’. The public were aghast when she succeeded, despite a spirited defence of Rosa’s sanity by John Haslam and allegations by other medical witnesses of dirty tricks by the family.

Especially in London, where many servants made care of the insane a speciality, families frequently hired a ‘keeper’. Thus Frances Backler stated that she ‘had been in the habit of waiting on insane ladies. Had made their state her study. Knows the theory of it.’ Though some of them undoubtedly conformed to the malevolent madhouse keepers of popular stereotype, this was by no means the rule. Some attendants became closely attached to their charges, another mark, Suzuki suggests, of the influence of evangelicalism, which prized companionship and advocated ‘unbosoming’. The troubled person was encouraged to ‘unbosom’ his inner sufferings as a way to re-establish trust, and re-enter the circle of intimacy, but also to provide the family with a surer grasp of how to control him. So-called domestic psychiatry may frequently have been self-serving, but extended kin networks in middle and upper-class families often went to extraordinary lengths to accommodate the troubled individual, sometimes arranging for them to be given a temporary home with another part of the family.

As the 19th century wore on, a deepening sense of ambiguity developed around the domestic management of the insane, until secrecy became suspicious, perhaps even verging on the criminal – unless you happened to belong to the upper classes, in which case you still had considerable discretion over the disposal of mad family members. When in 1915 Maurice Craig, the eminent Edwardian psychiatrist, interviewed William Grosvenor, then aged 20, and second in line to the Duke of Westminster, he found that his client ‘would talk of nothing but dogs’. Craig saw him again in 1920, but this time complained that William’s ‘whole conversation is about women’. This might have been considered a sign that he was growing up, were it not for a report that William had ‘recently been going out with a woman much lower in station to himself with whom he contemplated marriage’. Craig took this for conclusive proof of weak-mindedness and duly obliged the Grosvenor family by pronouncing William an ‘imbecile’ and hence a proper person to be taken into care. Significantly, an inquiry the previous year had come to the opposite conclusion. When William Grosvenor eventually succeeded to the title in 1953, becoming the third Duke of Westminster, he was described by the Times as ‘a bachelor living in retirement’. Whether this was a euphemism for a ‘burrowsed’ existence the record does not reveal, but it was very obviously a life that had been lived within the confines of the domestic psychiatry that Suzuki has described so ably.

It would be a mistake to assume that the resonances of his study are restricted to the upper classes. In a celebrated essay from the early 1970s, Erving Goffman explored ‘the insanity of place’, the havoc inflicted on a household by the apparent failure, or inability, of one family member to maintain his or her place in the network of relationships. The family had to respond not only to the disruptions of its inner life but also to the spectacle that the individual was making of him or herself in the community. Ironist that he was, Goffman distanced himself from the contemporary culture of culpability, in which the family is made to take the rap for a multiplicity of ills. His purpose was not to apportion blame but to show how the ways in which we codify and cope with ‘madness’ are inextricably interwoven with the wider context of ‘relations in public’.

Suzuki worries in his conclusion that he is ‘putting the family in a most unfavourable light’, but in fact Madness at Home lends historical depth to exactly the domain of relations in public that Goffman identified, in which the definition, understanding and treatment of ‘madness’ can never be a matter of ‘pure’ science or ‘pure’ psychiatry, but instead has to be accomplished by negotiation between a range of diverse, and often competing, actors and agencies. Shrewd practitioners realised, Suzuki claims, that ‘the business of psychiatry was a catch 22, inset within the unsolvable dilemma of science and practice’; ‘as to the physician,’ Goffman writes, ‘he finds that he must join the family’s faction or the patient’s, and that neither recourse is particularly tenable.’

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