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Reviewed by:
  • Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry. (Clio Medica 73)
  • Michael King
Jonathan Andrews and Anne Digby, eds. Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry. (Clio Medica 73). New York, Rodopi, 2004. 338 pp., illus. $51 (paper).

The past forty years have seen a rush of historical interest in the influence of gender and class on the definition and management of mental illness. Revisionist histories of medicine, as seen in the writings of Michel Foucault and Andrew Scull, have influenced our understanding of the social and cultural context of the growth of asylums in nineteenth-century Europe and North America, as well as our current attitudes to mental illness. Insanity in Victorian times and earlier came to be regarded as a "female malady," and feminist critiques of this subject made for popular reading. Writers such as Elaine Showalter claimed that there was a gender bias in psychiatric practice; behaviors that did not fit sanctioned (particularly Victorian) roles for women were diagnosed by male alienists as insanity. Social constructions of madness were a response to the flouting of conventional behavior by lower-class people and particularly women. However, these writings were mainly based on elite literary and professional source material. In their haste to construct theories, revisionists neglected available legal, family, and parochial records that offered access to the accounts of ordinary people and their doctors.

This collection of essays examines the influence of class and gender in the practice of psychiatry in four countries and reveals how the psychiatric institution was an organization that reflected broader social trends. It is written mainly by historians, philosophers, and sociologists who have direct experience of archival material from institutions in the United Kingdom and Ireland. The editors introduce the book as a "post-revisionist critique" that sets itself against the theoretical and ideological literature of feminist writers and post-modern philosophers.

Several reflections arise from this work. First, eighteenth- and nineteenth-century definitions of lunacy, idiocy, and madness were relatively precise. "Idle" or eccentric people were rarely labeled as mad. Rather than being an oppressive act, defining madness was a subtle and nuanced way of understanding unusual beliefs and behaviors. Mad people suffered from defects in judgment that led to irrational speech and actions.

Men and women were often admitted to asylums because they fell afoul of the enormous economic and psychological pressures of their times. The Victorian attachment to the work ethic meant that people who fell short of this ideal found themselves on a pathway to the workhouse and sometimes to the asylum. [End Page 87]

Rather than being an instrument of social control and containment, the asylum was often seen by members of the working class as a refuge from the insane pressures in the world around them. Many men and women were admitted to regain physical and psychological health.

Far from there being a disproportionate ratio of women in the asylums in the nineteenth century, men and women appeared to have had fairly equal chances of being admitted. Women's dependent status made them particularly vulnerable to poverty, and admission to an asylum was often a way of escaping extreme deprivation even for a brief period. Thus the asylums served a welfare function to which families resorted to obtain temporary relief for their ailing relatives and neighbors.

Class played a definitive part in the management of mental illness, and many asylums reflected the social class structure in the surrounding society.

Showalter and colleagues have argued that the asylum was effectively an enforcer of gender norms. It certainly seems that the threat of asylum played a disciplinary role within society to a small extent, but admissions for flouting gender norms outside the context of blatantly irrational behavior were rare. Assumptions about the fragility of women's reproductive function are present in these records as causes of insanity, but they are far outweighed by the influence of grinding poverty and (lack of) work. Because social and legal norms of the Victorian period held that women were dependent on men and that work could not be...

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