‘So-called Puerperal Insanity’: Diagnosing Postnatal Mental Illness (late 19th- early 20th century) | Institute of Advanced Studies (IAS)

After the 1870s the separate existence of puerperal insanity began to be questioned in the medical literature, a process reinforced early in the twentieth century when it appeared to have been eliminated from the psychiatric canon, the coincidence of childbearing and insanity no longer regarded as sufficient to warrant a discrete diagnosis. Textbooks of psychiatry steadily abandoned the term, and, in 1906, when the Medico-Psychological Association drew up new tables defining forms of insanity, puerperal insanity was removed as a diagnostic category in a new classification abstracting symptoms from bodily states, as part of a shift towards Kraepelinian concepts and taxonomy.

This paper explores the implications of these changes in practice. Taking case studies from London County Council asylums and Rainhill Asylum in Liverpool, it examines the responses of asylum doctors to debates about the role of childbirth in prompting mental illness and to classificatory revisions. Drawing on asylum reports and casebooks, the presentation asks whether labels previously valued for their clarity and accuracy in describing mental illness linked to childbirth were discarded. Practice appears to have varied. Pregnancy, childbirth and lactation continued to feature as key exciting causes of mental breakdown in all asylums. For some asylum doctors, puerperal insanity remained a valid and important nosological entity; in other cases, a desultory approach was taken to providing a diagnosis. Interpretations of women’s mental disorder in cases related to childbearing might also be complex and ‘blended’, shaped by experience and local knowledge, and acknowledging the impact of poverty and hardship, chaotic lives and stress, alcohol abuse and domestic violence.

The presentation also reflects briefly on the persistence of diagnostic ambiguity through the twentieth- and twenty-first centuries, in terms of recognising postnatal mental disorders as distinct conditions. Postpartum psychosis was excluded as a standalone diagnosis from DSM-V, and debates continue concerning causality and risk factors.

All welcome – booking not required.

The UCL Health Humanities Centre draws together staff from different disciplines, departments and faculties engaged in teaching and research on matters relating to health, illness and well-being.

Image: