The Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the earliest times to the present day. This week Julie Jakeway introduces her new book that explores the lives of women sent to the Norfolk Country Lunatic Asylum in the nineteenth century.
My book, Manifestations of Madness, Women’s Voices from the Norfolk County Lunatic Asylum, features female patients in Norfolk Lunatic Asylum diagnosed with gender-specific causes of insanity during the period between 1851 and 1870. Biological factors were highlighted in the nineteenth century to explain the incidence of insanity in women, and the debate concerning the female malady, as it was termed, continues to be of interest in the twenty-first century. Victorian psychiatrists held the view that ‘women were more vulnerable to insanity than men because the instability of the reproductive systems interfered with their sexual, emotional and rational control’.[i]
Following childbirth women are vulnerable to moods that today are recognised as postnatal depression but in the Victorian era these unexpected moods, ranging from ‘baby blues’ to more serious postnatal melancholia, meant many women were diagnosed with lunacy and admitted to the asylum. The causes of their ‘lunacy’, often aggravated by malnourishment and hard labour, led to a period of confinement and were recorded in layman’s terms variously as confinement, childbirth, pregnancy and so on. My research focuses on the personal history of patients diagnosed with gender-specific causes of insanity through a series of case studies from within the asylum.
Whilst women’s issues at significant times in their lives were being recognised by the medical profession in the nineteenth century, treatment differed between the classes and middle-class women were more likely to be cared for in their own homes, and frequently advised to avoid unnecessary strain such as reading or writing, activities that were considered over-taxing to their brains.[ii] Working-class women on the other hand, frequently undernourished and physically exhausted, were provided with more basic needs by the county asylums, which was sometimes enough for their recovery.
This recognition of women’s vulnerability postpartum resulted in an increased rate of admissions amongst women featuring the specifically female events of accouchement, lactation, parturition, and puerperal fever. Their case notes suggest their physical condition was frail and the substantial demands of parturition and lactation further drained their strength, already weakened by hard labour and malnourishment.
There were other gender-specific causes of insanity in addition to those directly linked with childbirth: amenorrhoea (lack of the menstrual cycle); hysteria (removed from the medical vocabulary in 1980); menorrhagia (excessive menstrual bleeding); uterine disturbance (irregular menstrual bleeding), and the menopause which was usually termed the change of life or climacteric in that era. Together these accounted for a significant percentage of female patients at Norfolk Lunatic Asylum in the twenty-year period between 1851 and 1870. The speed with which some patients recovered their mental and physical health within the asylum is quite astonishing, bearing in mind there was rarely, if any, medication involved in their treatment. This success seems to confirm the sentiments of William Hills, medical superintendent, recorded in the Annual Report of 1863:
‘The earlier patients are placed under medical [care] the better; in cases of insanity, this rule is of vital importance, as the neglect of it, converts a curable condition into a chronic one requiring permanent residence. The average residence in the asylum of those, who recovered, is about 5 months, the longest was three years.’[iii]
The provision of regular meals, comfortable accommodation, bathing facilities and clean clothing met the basic needs of those patients who were living in dire conditions, and this was sometimes enough to restore their mental, as well as their physical, health. Four shillings (£16.04 is the equivalent based on www.nationalarchives.gov.uk/currency-converter July 2020) was allotted for each patient’s food each week, twice the amount that Norfolk farm labourers were able to spend.[iv] However, as well as those restored to health by the usual asylum regime of therapeutic treatment, there were instances in this new field of medicine where the diagnosis was flawed and patients’ outcomes did not end as happily.
The high proportion of gender-specific causes assigned to women patients meant the label of ‘women’s problems’ as the cause of their mental disorder was a useful classification when no other explanation was apparent. The focus of my book is the women whose lives, through poverty, debility and the stresses of everyday life, brought them to the asylum for a period of refuge, and how their lives evolved in the years that followed. I have included twenty-one case studies in Manifestations of Madness which follows the patients’ lives after their discharge from the asylum.
Today mental health problems remain as prolific as ever: depression, stress, anxiety; an inability to cope with the requirements of modern living. Physical exhaustion and starvation are less likely to be diagnosed as causes of mental illness nowadays yet the pressures of daily living continues to affect our society: intense media pressure has been identified as just one contemporary cause of anxiety and distress.
Julie Jakeway, educated at Carew School, Ealing, went on to study at the Guildhall School of Music and Drama for a Licentiate Diploma in Drama. She taught at Lonsdale School, Norwich, before working as a team leader in local government.
Her dissertation for an MA in Local History from Leicester University was on the subject of the Norfolk County Lunatic Asylum. Her subsequent research into the personal histories of the female patients of the asylum in the period between 1851 and 1870 led to the publication of Manifestations of Madness, Women’s Voices from the Norfolk County Lunatic Asylum in 2021. The book is available from bookshops, Amazon and Poppyland Publishing at: https://poppyland.co.uk/products/B79685
[i] E. Showalter, The Female Malady: Women, Madness, and English Culture, 1830-1980 (London, 1985), p. 55
[ii] Charlotte Perkins Gilmore, The Yellow Wallpaper (London, 2009), p. 4
[iii] Norfolk C.R.O. SAH 28, Annual Report, 1854-73
[iv] A. Digby, Pauper Palaces, (Routledge & Kegan Paul, London, 1978), p.23