Throughout my research of the patient case
notes of the Garlands Asylum, I have been struck by the emotions that emerge
from these clinical documents. Although they contain a high amount of
biographical and medical information, the circumstances surrounding a patient’s
committal can also offer a glimpse into the emotions experienced by those being
admitted. This blog post will offer two examples of female patients who were
brought to Garlands in its opening few years, who display the emotions acting
upon them on committal.
First, Ann R, aged 50, a housekeeper from
Whitehaven, was admitted in March 1863 experiencing suicidal thoughts. Before
coming to Garlands, it was stated in her notes that she:
made
two attempts to destroy herself. Escaped from her home one day last week and
was brought back again by a Policeman, who found her upon the sea-shore with
part of her clothes off, and was told she had been making an attempt to drown
herself. Her daughter also informed me she took a razor from her a short time
ago, with which she believed her mother meant to injure herself.
The cause of her melancholia was given as:
‘Heard that her husband who has been in
Australia has married another woman.’ It is uncertain whether or not Ann
had separated from her husband, or if he had just taken off and the news had
made its way back to her. Whatever the circumstances, it is clear that the
event caused Ann to break down emotionally, and led her to take steps to end
her life. Doctors noted on admission that she was: ‘Very melancholic and dejected. Will not enter into any conversation
whatever.’ After six months treatment in Garlands, her spirits seemed to be
lifted, and her case notes stated: ‘For a
week she has been much more cheerful, quite a different woman in fact, entering
into the amusements…with her fellow patients.’ However, she did relapse,
and slipped back into a melancholic state. As a result, she remained in
Garlands for just under two years, when she was discharged recovered.
Second, Sarah C, aged 18, a weaver from
Carlisle, was admitted in June 1862, also suffering from melancholia. The
official cause diagnosed in her notes was ‘suppression of menstruation’.
Although this was the era of the emergence of psychiatry as a medical area of
specialisation, the ancient beliefs regarding women and their reproductive
systems still prevailed as a cause of mental illness. Women were considered to be
increasingly susceptible to emotional disorder, particularly at certain points
of their lives. Puberty, pregnancy, lactation, menstruation, and menopause,
were all key events that could ‘shock’ the female body, prompting a mental
breakdown.[i]
On admission, there was a lengthy
statement of facts indicating the events leading to her melancholia, which
includes vast information surrounding the economic circumstances of Sarah and
her family:
‘The
history of her care taken today from her mother (who is a widow earning only
2/6 a week weaving in Dixon’s Factory and with 5 children younger than our
patient) is that the girl has worked hard and tried hard, that she has been
well up to six weeks since, that then the catamenia ceased, she having been
regular from 15 years old up to that time. The mother considers this to be the
cause of her illness and that directly ‘they’ flew to her head…She appears
frightened, gets no sleep, is restless, melancholy and of a religious turn of
mind. She has been a respectable, steady, moral and industrious girl, has a
constant habit of reading religious books. Dr Elliott signs the order for
admission and Mr Reeves who signs the medical certificate says ‘that however
much questioned she appears vacant and sometimes won’t answer but remains
silent, she has religious misconceptions and that she is going to die and that
she is lost; she is restless and difficult to keep quiet; the least noise
terrifies her and she is painfully nervous – will not keep in bed late gets out
creeps under the bed and tries to get out of the window – mothers direction,
Sarah C, Duke St Carlisle.’
For
us reading this in the twenty-first century, it appears that the ‘suppression
of menstruation’ had very little impact on her mental health. The burden of
being one of the main wage earners, in the absence of her father, of a large family, would have laid heavily
on a young woman. The pressure to survive in such poor and desperate
circumstances, clearly led to her worry and caused her restlessness. In the absence of
talking therapy in this era, asylum doctors strove to look for physical
symptoms of illness (or significant events, as with Ann above), and could overlook the fact that poverty and overwork could contribute to an individual’s
melancholia.
Sarah remained in the asylum for nine months. After showing little
improvement, she was removed by her mother in March 1863, presumably has her
wage earning capacity was being missed by her family. The realisation that
asylum treatment was having no effect, but while in Garlands Sarah was capable
of doing needlework, would have been a signal that she could still function in
a manual work. I have so far not found any further trace of Sarah in Garlands,
but it would be interesting to find if she was able to cope with life on the
outside.
These
two brief patient examples highlight an additional importance of asylum case
books. Primarily intended to be a medical record of a patient’s history,
symptoms, diagnosis, physical health, and reaction to treatment whilst in the
asylum, these documents can also contain fleeting moments of emotion which the
patients experienced. A degree of estimation and ‘reading-between-the-lines’,
backed up by cross-referencing these records with census/birth/marriage/death
material, can lead to fascinating patient histories emerging. This further
humanises these clinical documents, and allows us to empathise with those who
experienced mental health care in the nineteenth century asylum.
