The Destabilization of Domestic Psychiatry

In Madness at home: the psychiatrist, the patient, and the family in England, l820–1860, Akihito Suzuki examines the forces that undermined, or as he puts it, destabilized, domestic psychiatry: the caring for lunatic family members at home. Standard accounts of the process by which families ‘‘lost the treatment franchise’’ have routinely focused on the rise of the asylum and the coming of the (mad) doctor. But by mining an unusual source—newspaper reports of commissions of lunacy from l825 to l861—Suzuki has put to marvellous effect some l96 accounts of the actors, the language, the depositions, as well as the public and professional reaction to the shifting meanings of lunacy in an era noted for qualitative change in both civil and criminal jurisprudence. In addressing how domestic care of the mad lost its legitimacy, he deftly engages a host of issues dear to the heart of historians of medicine: the vagaries that surround a clinical diagnosis, the yawning gap that opens between professed medical opinion and actual medical practice, the motives thought to animate various actors who participated in the designation and sequestration of the mad in nineteenth-century England. It is ultimately the fine art of diagnosis that threads its way through this comprehensive and intelligently written study. Although readers in medical history have grown familiar with the proffering of professional, political, and even venal motives believed to have framed the Victorian medical gaze, it is frankly difficult to finish Madness at home without a certain compassion for the predicament facing the period’s specialists in mental medicine. As Suzuki makes clear, patients could actively mislead the physician, carefully circumnavigating delusional shoals to appear perfectly sane; relatives with an eye to recovering or protecting family property could manipulate the physician’s inference in quite the other direction, tendentiously embellishing the narrative of their allegedly mad relative’s antics. Even when supplied with a truthful history, where was the physician to look in order to translate florid accounts of seeming derangement into a diagnosis of lunacy? The professional literature, such as it was, contained only vague and imprecise criteria for the designation of madness; the expressed opinion of one’s colleagues could be just as unhelpful. If there remain readers today who need to be reminded of the sui generis nature of psychiatric diagnosis, they have only to try to name another medical specialty whose practitioners could advise: ‘‘an ideal . . . clinical encounter was one without the patient’’ (p. 54). George Man Burrows, the author of this particular sentiment, would pay dearly for his self-regarding skills: he was brought low in a legal action that resulted from signing a lunacy certificate