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Introduction to Chapter 4 In her discussion of puerperal insanity, Nancy Theriot provides a rich and satisfying analysis of the interrelatedness of larger cultural notions and technical knowledge. As Marcus has given us a powerful portrait of the shift of u.s. culture from the age of individualism to the age of the group, so Theriot's discussion of this important yet baffling affliction demonstrates again the importance of group identities and designations after the 184Os. The group, of course, was an invention of democratic culture, whether one thinks of post-l830s revivalism, the political party, the new understandings of corporations, or even that all-pervasive "associationist principle" that so dominated American cultural and social behavior in the middle decades of the nineteenth century. And what was this strange disease? Puerperal insanity-literally, hysterical behavior patterns of new mothers following childbirth-appeared to be common in nineteenth-century America to most physicians, even though they. described it in different ways at different times. It was responsible, Theriot indicates, for at least ten percent of female admissions to insane asylums, an arresting statistic indeed. Yet by the dawning of the twentieth century, it had all but disappeared. Like any other disease that "disappears;' its history raises interesting questions. It can be seen, as Theriot depicts it, as a socially constructed illness and disease in the mid- and later nineteenth century, constructed in different ways by the different interests or groups involved in the phenomenon as a whole. For the women so afflicted, the proper perspective was the constrained roles that women played in society, including those with their medical doctors and alienists. For the doctors the illness was a manifestation of a category of patients and categories of pro73 74 Introduction: Chapter 4 fessional expertise. For the woman's family, the identity of the patient, physician , medical establishment, and family itself were crucial. Theriot insists that puerperal insanity may be regarded as a socially and culturally constructed disease; it reflected both gender restraints and professional battles accompanying medical specialization. She notes that discussions of the afHiction shifted from a relatively soft attitudinal phenomenon to a hard, seemingly biologically caused behavioral malady after the 1870S and that after 1900 discussions of the disease evaporated from the medical literature. Also, twentieth-century medicine was less tolerant of such categories as puerperal insanity. Thus, Theriot concludes, it may be inferred that the disease was the cultural construct or product of certain cultural notions in a particular age. Theriot's study reminds us of another important shift in nineteenth-century American cultural life, that which the literary historians have called the transit from romanticism to realism, from an age of the transcendant spirit, or Geist, to an era in which the material aspects of life dominated sensibilities and perspectives. Indeed, the different medical systems of Marcus's Cincinnati doctors and the literary historians' depictions of transcendentalism in American literature would appear to be parallel phenomena in the same period, and the so-called moral reform movements of the three decades following 1830 might be thought of in the same light, for their champions defined America as a society and culture populated by many distinct groups and called for ideological proscriptions for the uplift of human behavior through the mechanism ofwholesale behavioral reorientation. And Theriot's emphasis on the sudden redefinition of puerperal insanity in the later nineteenth century as having a biological base is congruent with much of what we know about cultural life in that era, including the Widespread acceptance, among educated Americans at least, of the new evolutionary theories of Lamarck, Spencer, and Darwin, and the even more important veneration of expertise and science. It was in the five decades following 1870 that the genteel tradition died in American cultural life and that Americans from many walks of life acted and spoke as if a person's social standing depended on skill, talent, or merit (or lack thereof), instead of character or reputation, as had been the case since the later eighteenth century. Above all, as Theriot's essay suggests (and as much other historical literature fortifies), what was so remarkable was the new veneration of expertise and the expert, as manifested in the rising reputation of the new professionals in general but also scientists and engineers and doctors in particular-those important manufacturers and purveyors of technical knowledge. NANCY M. THERIOT Diagnosing Unnatural Motherhood: Nineteenth-Century Physicians and "Puerperal Insanity" 4 On December 16, 1878, Elizabeth S., age twenty-seven, was admitted...

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