Madness at Home: The Psychiatrist, the Patient, & the Family in England, 1820–1860 (review)

In 1970s scholarship, the Victorian lunatic asylum became the archetypal locus of social control. Depending upon the author, the mental hospital was a social repository for the unwanted elderly, the urban residuum, the idle and unproductive, or rebellious women. Borrowing from the writings of Ervin Goffman and others, the lunatic asylum was characterized as a "total institution," cut off from the society from whence its inmates came. It came to dominate, we are told, the landscape of mental health, while all other forms of care and control were marginalized. Meanwhile, the medical profession achieved monopoly status, despite an evident lack of success in curing insanity.

With the rise of the social history of medicine in the 1980s and 1990s, a new and more complicated picture has emerged of the nineteenth-century lunatic asylum. The patient populations of public mental hospitals, we have discovered, were made up of a remarkable cross-section of nineteenth-century society; private institutions persisted and indeed flourished; men as well as women were the objects of control; many patients stayed only briefly in these institutions before being discharged; indeed, many of those recognized as insane in the Victorian period were never institutionalized at all. Such results have led to a dramatic revision of our understanding of the mental hospital and a revolution in our conceptualization of social responses to madness during the Victorian era.

Akihito Suzuki has been on the forefront of this historiographical revision. He is a well-known researcher who mixes rich theoretical perspectives with delicate archival research. His book, Madness at Home, is the most thorough account to date of one important theme in this historical re-evaluation of madness: namely, the role of the family in the social regulation of the insane in early-nineteenth-century England. He attempts to reconstruct a "domestic psychiatry," in contradistinction to the idealized institutional psychiatry articulated in formal medical treatises of the time.

Suzuki turns to a series of relatively obscure and certainly underused legal documents as his primary source material. Commissions of lunacy (commissions de lunatico inquirendo) were proceedings in which families sought state intervention in cases where the head of household had become insane—and thus threatened family property. These cases date back to legal precedents in the late medieval and early modern periods that articulated the principle of parens patriae (the state as guardian). In practice, these legal interventions involved prosperous families since in the cases of the poor there was no significant property at stake. Lunacy commissions (not to be confused with The Lunacy Commission, the official inspectorate in England and Wales from 1845), were widely publicized in the English press. They also attracted spectators.

For Suzuki, the recorded testimony of these public events reveals the power the family clearly had over the definition of madness and the daily practice of psychiatry. In contrast to an all-powerful psychiatric elite trumpeted by Michel Foucault, Andrew Scull, Elaine Showalter, and others, Suzuki suggests that, in the negotiation over meanings of madness and its remediation, the family had the upper hand. Bereft of any technological power to justify their scientific superiority (as would emerge with diagnostic technology and laboratory science in the last quarter of the century) psychiatrists were dependent on the life stories of the family for the formulation of their diagnosis. Although historians of Victorian madness have been preoccupied with the subject of wrongful confinement, Suzuki argues perceptively that commissions of lunacy were more about the protection and control of property than about the deprivation of civil liberties.

Suzuki's book is a landmark study in the history of madness. Its sophisticated scholarship and challenging arguments should fundamentally transform the way we approach the history of madness in the Victorian era. By way of critical comment, one wonders whether the author's detailed readings of commissions of lunacy implicitly exaggerate the options open to poorer families who did...