In this analysis of the role of
families in 19^th century psychiatry Akahito Suzuki provides a new
perspective on a critical period in the history of madness. Arguing against the
revisionist view that psychiatry aligned itself with social interests to build
an empire based on asylums, Suzuki argues that between 1820 and 1860 families
played a central role in the definition, policing and control of madness, a
role that was only gradually usurped by medicine. The argument applies only to
middle class and wealthy families, not to the large numbers from the working
class incarcerated in asylums. And this new analysis is intended to nuance
rather than supplant the revisionist view. But despite these limitations Madness
at Home offers rich new insights into 19^th century madness and
psychiatry.

The book is structured to provide a
background to the legal framework of the period, then explores psychiatric
practice, the role of property interests in psychiatric decision making, and
the place of psychiatry within the domestic sphere. Throughout the book the
valorization of the Victorian family serves as the backcloth to Suzuki’s
thesis. Notions of the Victorian family as a warm and protective institution
were supported by legal procedures that protected their status, and most
importantly, their property. It is this emphasis on property that is crucial to
understanding how families contributed to the legitimacy of psychiatry, lending
it a conditional power; conditional on psychiatry’s performance in protecting
family financial interests. This is not merely a restatement of the argument
that families played a coercive role in the asylum era, an argument that
emphasizes families’ emotional motivation for invoking psychiatric power.
Suzuki departs from this understanding to stress the family’s financial
motivation for psychiatric coercion. He argues that psychiatry was heavily
dependent on families to supply the patient’s history, the fundamental element
in judging an individual insane. Physicians could do little through their own
history taking or examination to add to the accounts provided by families.

To properly understand Suzuki’s argument it is
necessary to understand two coexisting but distinct legal procedures in
relation to lunacy, a distinction, according to Suzuki, that has eluded some
historians. A commission of lunacy was a legal procedure aimed at protecting
the property interests of family members by constraining the legal power of an
family member to make important personal and financial decisions. By returning
a verdict of lunacy a commission could annul marriages, dissolve contracts, and
prevent a family member from signing checks, but there was no necessary
confinement. A commission was a public hearing, often with theatrical and
melodramatic overtones, with a jury determining whether the charge of lunacy
was proved. A separate and distinct legal procedure, the certificate of lunacy,
was necessary to confine and individual to his or her home, or to a madhouse or
asylum. Most importantly, a commission of lunacy could declare an individual
unfit to manage his of her affairs. Commissions of lunacy are sometimes
confused with the Lunacy Commission, a quasi-judicial investigative body
established 1845, with a variety of powers in the administration of asylums and
the treatment of lunatics.

To establish the role of
commissions of lunacy in the management of madness, Suzuki studied the
available documentary evidence of their proceedings, as well as the often
fulsome and lurid reports in the press. His meticulous attention to the written
record, appropriately qualified by pointing out where it is incomplete or open
to interpretation that makes this book both compelling and convincing. Besides
documenting the numbers of commissions of lunacy over the period study, Suzuki
makes extensive use of detailed case studies to illustrate the central role
played by families. Any of these case studies would make a worthy publication
by itself, especially given the way Suzuki contextualizes events, relating them
to the prevailing political and social climate.

Chapter Two contains the intriguing
story of the hubris and demise of Dr. Burrows, author of the Compendium, British
psychiatry’s definitive work at the time. Like many figures in the history of
psychiatry, Burrows was something of a contradiction, espousing an
uncompromising form of somaticism (he even claimed to be able to ‘smell out’
mania), while at the same time depending heavily on families’ accounts of
madness. Suzuki uses Burrows’ case to provide a detailed analysis of the gap
between the way psychiatry of the time was theorized, and the way it was
practiced. He describes this as an epistemological contradiction: There was no
evidence to support Burrows’ somatic theory, and Burrows did not argue on that
basis when presenting an opinion to a commission of lunacy. He argued on the
basis of the history supplied by the family. Two cases of wrongful confinement,
those of Davies and Anderdon, were established against Burrows, cases that Suzuki
argues arose directly from the contradictions that underpinned his theory of
psychiatry. The result was professional ruin for Burrows. In a further irony,
psychiatry’s resolution of this crisis was to incorporate the family history
into the psychiatric examination, not to exclude it.

Suzuki returns to the Anderdon and
Burrows cases in the following chapter, in which he explores the varying
responses of eminent psychiatrists to the ensuing crisis. John Conolly, famous
for his policy of non-restraint at the Hanwell asylum, took the view that
eccentric behavior was not a sufficient condition for a finding of lunacy. Conolly’s
insistence on something like a dangerousness criteria has a modern feel to it.
Charles Dunne, himself discharged from the army on grounds of insanity, held
the more romantic view that insanity was a natural part of the human condition,
lending some support to the notion that eccentricity might be a manifestation
of insanity. The result of the Burrows crisis placed families at some risk by
depriving them of a legal procedure aimed at protecting their wealth from the
profligacy of one of their members.

To repair this breach the concept
of moral insanity, something with clear connections to contemporary practice,
was championed by J. C. Prichard. Moral insanity expanded the notion of
insanity from a defect of reason alone. Now, the morality of behaviour (for
these purposes defined in terms of responsibilities to the Victorian ideal of
family) became grist to the psychiatric mill. Relating this development to the
central argument of the book, Suzuki shows how the notion of moral insanity
ensured the importance of the family narrative in psychiatric practice.

In chapter four Suzuki explores
what he terms ‘domestic psychiatry’: household beliefs and practices in
relation to madness. The case of Hastings Middleton is examined in detail, and
provides a vivid illustration. Middleton’s mother became mentally unwell late
in life, and Middleton had well a developed framework for both understanding her
madness and making decisions about its management. The widespread domestic
belief in an interpersonal / environmental model saw some wealthy households
employ physicians not for their medical skills, but as live in companions for
mad family members. For the aristocrats, as always less romantic, an arranged
marriage was a convenient means of containing madness and preserving property.
The full explication of Suzuki’s ‘domestic psychiatry’ leads to a revision of
the theory of Foucault, Scull and others, that institutional psychiatry
dictated public beliefs. Instead, Suzuki proposes that institutional
psychiatry, and in particular moral treatment, represented the incorporation of
practices long prevalent in families, and was thus consistent with, rather than
supplanting domestic practices.

Although the domestic sphere
exerted considerable power in the lunacy business, it also had its limitations,
explored in chapter five. Here, Suzuki introduces further case studies showing
examples of failure to contain lunacy. In these cases, outsiders intervened to
bring commissions of lunacy, using as their standard the prevailing norms of
family behavior, particularly that of patriarchs. In this chapter Suzuki offers
a further challenge to historical orthodoxies, arguing that Showalter’s notion
of the ‘female malady’ is but one piece of the jigsaw of Victorian psychiatry.
Men too, were subject to normative judgments based on gendered expectations,
and Suzuki argues that women’s madness should not be considered entirely located
within the domestic sphere. By the middle of the 19^th century the
state claimed a greater role in the care of lunatics, diminishing the
importance of the domestic sphere, and the power of middle and upper class
families. But current practitioners will look with more than a little interest
at this crucial period, and to the place of the family history in psychiatric
assessment. As a footnote to this, in my own country the mental health
legislation was amended in 1999, at the instigation of family advocates, to
oblige clinicians to consult with families of those placed under civil
commitment.

Madness at Home is a richly
detailed and important contribution to our understanding of 19^th
century psychiatry. It is of interest to both professional historians and
clinical practitioners with an interest in the history of their profession.
Those teaching courses in the history of psychiatry will find it difficult to
cover their topic without reference to this work, and as a result will be able
to provide students with a more nuanced account of the rise of psychiatry and
the role of families.

©
2006 Tony O’Brien

Tony O’Brien RN, MPhil, Senior
Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz

Categories: Philosophical, MentalHealth