Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (review)

This book is an important addition to the history of women and gender in the Victorian period, to the history of psychiatry, and to criminal justice history on infanticide and insanity defences. What emerges clearly from the pages of Dangerous Motherhood: Insanity and Childbirth in Victorian Britain is the depth and care of research, resulting in a study of puerperal insanity that will remain the authoritative work for many years to come.

Hilary Marland moves skilfully from elaborating a complicated nineteenth-century context, to the description and analyses of individual stories. The reader gets a clear sense of what puerperal insanity—severe mania and melancholia after the birth of a child—meant for emerging medical specialisations and for Victorian culture's investment in femininity and maternity. Yet we also begin to understand what puerperal insanity meant—indeed almost how it felt—for individual women. Marland shows that most women diagnosed with puerperal insanity were poor. Yet part of the richness of this book is her reach across classes in her analysis of this quintessentially female condition. The book opens with a sweep from Isabella Thackeray, wife of the author, to Janet Smith, a Welsh farmer's daughter as it studies accounts from and about both well-known and obscure women.

Importantly, Marland relates puerperal insanity to normative ideas on femininity and maternity which were strengthening over the nineteenth century. Her argument is that "it was largely because notions of femininity and maternity began to be so clearly expressed, that puerperal insanity became so visible and appeared to be so threatening" (8). This is most clearly demonstrated in the chapter on infanticide. The mother who kills her infant was the inverse figure of the devoted and protective Victorian mother. But it was precisely the precarious closeness between the sane, loving mother, and puerperal insanity that made the latter so threatening, literally and culturally. Motherhood itself was dangerous in several senses.

Marland traces the emergence and consolidation of the pathology of puerperal insanity from seventeenth- and eighteenth-century accounts of erratic behaviour, suicidal feeling, and melancholy around childbirth to the extensive discussion in mid-nineteenth-century medical journals—that is, to the point where puerperal insanity had become a well-known and much debated condition. She frames this shift well within the large changes in confinement practice and experience. While not arguing that the large increase in male attendance was causative of puerperal insanity, she demonstrates how the condition was the object of much professional scrutiny and concern in an era when specialties were being actively constituted. This was one of the key elements in defining the divisions between the work of alienists and the work of accoucheurs and specialists in midwifery and women's diseases. As she argues, "the stakes in claiming competence were high" (143).

Marland's topic is also partly the history of the increase in recourse to asylum for insanity over the nineteenth century. In this way, the book moves appropriately between the domestic and the institutional, analysing femininity and maternity in each. Marland looks closely at the Royal Edinburgh Asylum in particular and details case notes of women between the 1840s and the 1870s. She argues that the asylum was increasingly promoted as the most effective place for cure and that puerperal insanity was seen by experts as the most curable form of insanity. She supplements research into the Edinburgh asylum with case histories from the Warwick County Lunatic Asylum, where the women were especially marked by poverty. The medical descriptions and concern for these women, presented and analysed by Marland, are quite remarkable for their length and detail, poignant and discursive accounts of "frustrated, exhausted, sad women" (143). She argues that, overall, both the medical profession and the law were sympathetic rather than punishing to women who had succumbed to puerperal insanity, generally understanding them as vulnerable, subject both to an inexplicable condition as well as explicable social influences oftentimes of poverty, violence, and hunger...