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  • Madness at Home: The Psychiatrist, the Patient, and the Family in England, 1820-1860
  • Geoffrey Reaume
Madness at Home: The Psychiatrist, the Patient, and the Family in England, 1820-1860. By Akihito Suzuki (Berkeley, University of California Press, 2006) 272 pp. $49.95

In his study about the role of family members in identifying a relative's behavior as mad and in need of intervention, Suzuki sets out to show that the family was the primary force in determining psychiatric treatment in nineteenth-century Britain. Thus does he seek to offer a different [End Page 113] emphasis in the historiography of psychiatry, which has focused on the rise of the asylum during this period and the presumed decline of the influence of the family in the care of mad relatives, in favor of state intervention and alienists who worked together to send the mad to places of confinement. Suzuki argues that families have not been given the attention that they deserve in caring for mad relatives at home and in influencing the emergent psychiatric profession through "domestic psychiatry." His most notable insight is in regard to the development of moral treatment, which, he argues, doctors observed in homes and then borrowed for their own practice.

Suzuki's research is based on Commissions of Lunacy proceedings to determine whether to declare someone insane that were reported in contemporary newspapers. These reports provide a window on family members' perspectives toward mad people within their own homes. Since the original documents from these hearings were lost or are inaccessible, Suzuki relied on newspaper accounts of 196 hearings reported in the Times (London), as well as other primary source documents, such as a son's writings about his mother. The most serious limitation of these sources is the fact that they refer only to well-to-do families. This elite view of madness at home calls for some caution in applying Suzuki's conclusions too widely; the views of families of the poor mad are not covered in this study. The author notes this limitation but does not draw its implications. Without a comparable study about how poor families in the nineteenth century viewed and treated their mad relatives in the home and how they interacted with the state and psychiatry, Suzuki's assertion that families trumped alienists must be taken with a grain of salt.

Nor is Suzuki's further claim of "men's new vulnerability" to being declared insane because of Evangelical moral strictures about proper domestic behavior proven on the basis of just seven cited cases (139–148). Suzuki acknowledges that cases of abusive fathers and husbands being confined for cruelty were "very rare." Males comprised about two-thirds of his sample subjects whom family members considered to be lunatics (148, 24).

The author's contribution is also seriously undermined by his generalized caricatures of mad people as putting on "performances," engaging in "antics" and "tricks," being equated with "homicidal maniacs," or as "depraved," "weak-minded," "subnormal," "cunning," and in need of control (32, 35–36, 68, 73, 116, 120, 128–129, 132, 139, 210). He even refers to a present-day "lunatic," as if it were appropriate terminology about people in the twenty-first century (135). Such views have more to do with "timeless" popular prejudices than an assessment of the people and historical evidence in this book.

Geoffrey Reaume
York University
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