Cover

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pp. 1-1

Title Page, Copyright, Dedication

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pp. i-vi

Contents

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pp. vii-viii

List of Illustrations

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pp. ix-x

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Acknowledgments

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pp. xi-xii

...At the Wellcome Institute for the History of Medicine in London, I was lucky to meet Jonathan Andrews, Peter Bartlett, Cheryce Kramer, Sonu Shamdasani, and Philip Wilson. Their help, encouragement, and lasting friendship were invaluable. The Institute’s teaching staff, particularly Bill Bynum, Chris Lawrence, and Michael Neve, were constantly supportive. My brief stay in Aberdeen, Scotland, was rewarded...

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Introduction: Psychiatry in the Privateand the Public Spheres

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pp. 1-11

...in psychiatric decision making, and second, because they are now assuming vital roles in social policies for the mentally ill in many developed countries. Mental diseases, particularly in their more severe forms, impair the sufferer’s ability to make proper decisions for and by him- or herself. The patient often fails or refuses to realize the very fact that he or she is ill. Therefore, recognizing the existence of the disease often has fallen to those who live with the patient, usually...

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1. Commissions of Lunacy: Background, Sources,and Content

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pp. 12-38

...disclosure of yet another scandal in high places.1 The major dramatis personae of the scandal were the third Earl of Portsmouth, his second wife, Mary Anne, and her lover, William Rowland Alder. Lord Portsmouth was born in 1767 and married Grace Norton in 1799. Grace died in 1813, and less than four months after her death, Lord Portsmouth married Mary Anne Hanson. Mary Anne was the eldest daughter...

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2. The Structure of Psychiatric Practice

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pp. 39-64

...The contrast between the sister’s narrative and that provided by the doctor is striking. The sister gave seven pages of detailed accounts of Mary and Helen’s personal circumstances, in which she presented her often acute observations of her sisters’ personalities from childhood onward. The doctor, in contrast, provided brief supplementary information about the recent development of the disease and largely...

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3. The Problems of Liberty and Property

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pp. 65-90

...familiar question of psychiatrists’ misdemeanors from a new perspective. Instead of attributing incidents of wrongful confinement to the lack of professional conscience or legal regulation, I attempted to uncover the epistemological structure underlying psychiatric practice. The practitioner’s trust of family members and the high status accorded to information they provided were key factors in the cases of Anderdon and Davies. Alienists had two kinds...

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4. Managing Lunatics within the Domestic Sphere

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pp. 91-118

...psychiatric practice. Practicing psychiatrists were often integrated into family affairs, largely playing an ancillary, if not always subordinate, part. Their more or less dependent position vis-à-vis the family marks a strong contrast to their claims to professional autonomy based on scientific medical expertise, so much trumpeted in the pages of medical treatises and articles. Psychiatrists could not live up to...

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5. Destabilizing the Domestic Psychiatric Regime

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pp. 119-150

...Centered on the notion of the family as a close-knit community of individual personalities bound together by mutual affection, a framework emerged for decoding and understanding insanity, as well as a set of strategies for the management of lunacy at home. Both the framework and the strategies were constructed around the power of personal influence exercised by those who knew the...

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6. Public Authorities and the Ambiguitiesof the Lunatic at Home

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pp. 151-178

...measures to control lunatics. Families’ attempts at containing the mentally disturbed were often seriously undermined and threatened by a multitude of factors: by the unruly behavior of the lunatics themselves; by internal discord among the family; by the intrusion of a curious crowd in public spaces; by the protest of lunatics who...

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Conclusion

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pp. 179-184

...1860, a period that coincided with the rise of psychiatry and of the asylum. I have analyzed both the internal dynamics and the external relations of families with insane members. My account has naturally included both the intrafamilial tensions and the intersections of the family and various agencies in the world outside, such as...

Appendix

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pp. 185-190

Notes

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pp. 191-232

Bibliography

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pp. 233-248

Index

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pp. 249-260