From Statistics to Diagnostics: Medical Certificates, Melancholia, and “Suicidal Propensities” in Victorian Psychiatry

In the second half of the nineteenth century, the view that “[e]very case of melancholia should be looked upon as having a suicidal tendency” dominated among British asylum physicians. However, a generation earlier medical texts on melancholia contained only sporadic references to “suicide” and fewer still to the adjective “suicidal.” The latter emerged as a medical concept in the early nineteenth century, chiefly through the medical certificates of insanity which were required in the admission of an individual into the asylum. The recording practices surrounding these certificates were standardized following the 1845 Lunacy Acts, and the data they produced was entered alongside diagnostic categories on the pages of asylum case books. The statistics emerging from asylums as a result of mandatory reporting to the Lunacy Commission allowed physicians to argue that of all “suicidal” lunatics, the majority were melancholic, and of all melancholics, the majority were “suicidal.” As historians have noted, “suicidal” was a broad concept used to describe a wide-ranging set of phenomena. This article will sketch out some of the events, acts, and processes which produced “suicidal” as a medical concept and a defining symptom of melancholia in Victorian medicine, showing how melancholia and “suicidal” became mutually constitutive. It will be suggested that the concept “suicidal” cannot be separated from these contexts that produced and conferred meaning upon it and that, following from this, “suicidal” never shared a simple, causal bond with “suicide.”