‘The Cruel Madness of Love’: Sex, Syphilis and Psychiatry in Scotland, 1880–1930 (review)

This is a meticulously researched and illuminating study of the history of general paralysis of the insane (GPI), which emerged as a new psychiatric disorder during the course of the nineteenth century, and of the epistemological relationship between syphilis and insanity which developed at this time. Drawing on historical and sociological work on the rise of the asylum and the complex history of madness in which it developed, notably the work of Andrew Scull in Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (1979), Gayle Davis focuses on the day-to-day clinical and diagnostic activities of asylums and aims to bridge a gap between the social and clinical histories of psychiatry. She works with published medical writings and clinical case notes, comparing the published and unpublished, and considers patient populations in terms of specific diagnostic categories. Researchers have tended either to treat these populations collectively or focus on categories that remain prominent within modern medicine, such as posttraumatic stress disorder. Through her careful study, Davis is able to tell a new story about syphilis. In doing so, she cautions against the assumption that case notes provide a patient perspective; they rarely contained patient testimony—even letters were heavily policed by asylum authorities—and patients were rarely consulted within the general admissions process.

The research forms part of a larger story in which Davis considers forms of institutionalized provision for the insane in Scotland during the nineteenth and early twentieth centuries, following the Lunacy (Scotland) Act of 1857 which gave rise to a more comprehensive system of care for the insane poor. By this time there were seventeen poorhouses—the equivalent of English workhouses—with lunatic wards in Scotland, and these accommodated over eight hundred patients. The focus is on four asylums, the Glasgow Royal Asylum, the Royal Edinburgh Asylum, the Barony Parochian Asylum (Woodilee), and the Midlothian and Peebles District Asylum. Davis notes ways in which the Scottish class system and social inequality were reflected in the Royal Edinburgh Asylum, where private patients and their families and officials and administrators advocated segregation by class. The habits of the pauper ranks would, it was believed, slow down recovery. By contrast, Woodilee admitted those in the scope of the Poor Law Acts and employed its inmates in work more than did other asylums. Patients were also divided by gender and the severity of their illness. Davis considers pre-laboratory diagnosis and the dramatic impact on treatment in the early twentieth century following two asylum laboratories in Edinburgh and Glasgow in 1897 and 1909, respectively. She also provides a comprehensive overview of the techniques and therapies employed in the Scottish asylum from 1880 to 1930, including the Wassermann Test, the traditional antisyphilitic mercury treatment, arsenical therapies, and malarial therapy of the 1920s.

Davis charts how responses to GPI were reframed along lines of blame and responsibility and degeneration, and clinical records reflected these shifts. Tobacco, alcohol, and “immoral habits” were seen as causes of GPI, and modern urban life was seen as a contributor to sexual excess, alcohol consumption, and an increase in the stresses of life and work; GPI was constructed as a disease of the city, a construction informed by discourses of degeneration. More generally, through the late nineteenth and early twentieth century, disease boundaries were expanded to include behavior patterns that would earlier have been considered immoral or criminal. British alienists tended to resist the explanation of GPI along hereditarian ideas, but, working at a time at which venereal disease was seen as punishment for promiscuity, a moral tone of disapproval found its way into asylum case notes. Davis notes a gendering of attitudes—men were considered more prone to GPI and more likely to indulge in alcoholic excesses—and observes that shame and social stigma might have discouraged women from seeking help. It was considered appropriate to diagnose...