New issue – History of Psychiatry

A new special issue of History of Psychiatry is now available online. It is entitled “Lunacy’s last rites: dying insane in Britain, c. 1629-1939” and includes the following articles:

Death and the dead-house in Victorian asylums: necroscopy versus mourning at the Royal Edinburgh Asylum, c. 1832–1901 (Jonathan Andrews)

This article examines the management and meaning of post-mortem examinations, and the spatial ordering of patients’ death, dissection and burial at the Victorian asylum, referencing a range of institutional contexts and exploiting a case study of the Royal Edinburgh Asylum. The routinizing of dissection and the development of the dead-house from a more marginal asylum sector to a lynchpin of laboratory medicine is stressed. External and internal pressure to modernize pathological research facilities is assessed alongside governmental, public and professional critiques of variable necroscopy practices. This is contextualized against wider issues and attitudes surrounding consent and funereal rituals. Onus is placed on tendencies in anatomizing insanity towards the conversion of deceased lunatics – pauper lunatics especially – into mere pathological specimens. On the other hand, significant but compromised resistance on the part of a minority of practitioners, relatives and the wider public is also identified.

‘Those, that die by reason of their madness’: dying insane in London, 1629–1830 (Jeremy Boulton and John Black)

Dying insane provoked ‘great fear, and apprehension’ in the minds of men and women. Death as a lunatic disrupted deathbed performance and rendered the victim incapable at law. This article examines lunacy as a cause of death in the metropolis between 1629 and 1830. It draws on new material from the admission registers of St Luke’s Hospital, existing data from Bethlem and the London Bills of Mortality and unique biographical data on pauper lunatics dying in the parish of St Martin in the Fields. The article argues that lunacy being ascribed as a cause of death had a distinctive chronology in this period. Those most vulnerable to the stigma of lunacy at death were those dying as parish paupers and those who inhabited metropolitan institutions.

Recording the many faces of death at the Denbigh Asylum, 1848–1938 (Pamela Michael and David Hirst)

The funeral was a symbolic event in Welsh society, and members of staff and relatives of patients at the Denbigh Asylum shared cultural assumptions about the importance of a final resting place for the body. Formal procedures following the death of a patient were governed by asylum rules and regulations. At Denbigh the asylum chaplain played an important role, both in terms of ministering to the dying and in performing the funeral ceremony. During the late nineteenth century the burial ground became a contested space as nonconformists and Roman Catholics fought against the ascendancy of the Anglican Church in Wales and demanded that patients be buried according to their religious affiliation. The lunatic asylum became a site for advancing the case for Welsh disestablishment. By the twentieth century, infectious diseases had become a serious concern, and the need to carry out screening and conduct post-mortem examinations resulted in the appointment of a pathologist, whose main role was to conduct biological and histological examinations to identify cases of tuberculosis, syphilis, dysentery, typhoid, influenza and other bodily diseases.

Explanations for death by suicide in northern Britain during the long eighteenth century (RA Houston)

This article uses coroners’ inquest findings, media such as newspapers, magazines, pamphlets and broadsides, and family correspondence (all drawn from Scotland and the north of England) as well as civil and criminal court records and medical and legal writings from both countries to explore perceptions of the link between state of mind and self-inflicted death. It asks how doctors, lawyers, families and ‘society’ at large conceptualized, responded to and coped with suicide, questioning the extent to which it became medicalized: i.e. consistently linked with mental pathology. The aim is to square the apparently clear-cut, but very different understandings of doctors and lawyers on the one hand and coroners’ inquests on the other with the more emotionally charged and morally complex ways those both close to and distant from attempted or successful suicides related to their situation.

‘Abnormalities and deformities’: the dissection and interment of the insane poor, 1832–1929 (Elizabeth T Hurren)

The body trade of anatomy schools in Victorian times that underpinned the expansion of medical education has been neglected. This article examines dissection records of insane paupers, sold to repay their welfare debt to society. Each cadaver was entered in an ‘Abnormalities and Deformities’ dissection book. Student doctors paid fees to anatomists to be taught the pathology of insanity under the Medical Act. Anatomists also dissected cadavers to do further brain and eye research on epilepsy and glaucoma in the insane. These bodies were often dissected to their extremities. Their fragmentary remains were then disposed of in a common grave. This secret body trade and its asylum supply-chain merit further work in disability studies and the history of psychiatry.

Under the shadow of maternity: birth, death and puerperal insanity in Victorian Britain (Hilary Marland)

Death and fear of death in cases of puerperal insanity can be linked to a much broader set of anxieties surrounding childbirth in Victorian Britain. Compared with other forms of mental affliction, puerperal insanity was known for its good prognosis, with many women recovering over the course of several months. Even so, a significant number of deaths were associated with the disorder, and a large proportion of sufferers struggled with urges to destroy their infants and themselves. The disorder evoked powerful delusions concerning death, with patients expressing intimations of mortality and longing for death.

Troubled proximities: asylums and cemeteries in nineteenth-century England (Chris Philo)

Asylums and cemeteries in nineteenth-century England were kindred spirits in the anxiety and exclusionary impulses that they engendered, leading them to be similarly exiled from nineteenth-century urban areas. They were uneasy ‘neighbours’, however, with contemporary authorities condemning the proximity of cemeteries to asylums on medical and moral grounds. The appearance at many asylums after mid-century of a burial-ground for deceased residents, usually located on an asylum’s own estate, was often criticized on grounds similar to those raised with respect to neighbouring parochial burial-grounds. Other objections arose to the ‘exclusivity’ of asylum-based burials, with off-site burial arrangements clearly being favoured. One consequence was that on-site asylum cemeteries ended up being treated as unwelcome occupants of asylum estates, hidden away as an embarrassment, creating a legacy of anonymity still generating concerns in the present.

‘Visitation by God’: rationalizing death in the Victorian asylum (Cathy Smith)

This article argues that death from insanity raised serious questions for the medical profession and for those who promoted the public asylum movement in the nineteenth century. While the medical emphasis on the somatic origins of insanity was increasingly accepted, limited observable signs of disease in the brain at post-mortem made it difficult to explain cause of death. This posed problems for a growing county asylum movement which was justified on the basis that insanity was a treatable disease and thus mortality rates would naturally decline. As asylum populations continued to grow and mortality rates remained little changed, statistics on lunacy ultimately became not the predicted measure of success but instead clear evidence of failure.

Welcome release: perspectives on death in the early county lunatic asylums, 1810–50 (Leonard Smith)

Deaths in the asylum could be interpreted as a sign of failure, particularly if they were related to the poor condition of those admitted, the spread of disease among patients, or the direct consequences of severe mental disorders. County asylum superintendents lamented the bad physical state in which many were sent to the asylum and the consequences for death rates. Due to limited consideration of environmental and sanitary matters before the 1830s, there was great risk of contracting fatal diseases in the asylum. Combined with the deteriorated physical condition of many patients, and the growing overcrowding, this had a notable influence on mortality. For some individual patients, death came about as a direct consequence of a profound mental disorder. Without effective treatments to confront manifestations of disordered thinking, mental symptoms might precipitate physical deterioration to the point of death, while severe distress led some to kill themselves in the asylum.

It also contains James Cowles Prichard’s classic text ‘Of the Termination of Insanity in Death’ (1835), with a commentary by Jonathan Andrews.

For more information, click here.

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