Literature and Medicine I

Women in the Medical Profession

Women Writers and the Pathologizing of Gender in 18th-Century English Mad-Discourse

by Michelle Iwen, Arizona State University, Tempe, AZ, USA

The Development of the Madhouse

1The development of asylum (madhouse[1]Use of the term madhouse has a more open interpretation than the term asylum. Asylum was to become synonymous with the means of promoting rationality and improvement with its architecture and scope.) culture in England during the long 18th century can be viewed as a function of localized, small-group normalizing.  Because of the lesser reliance on religious faith and the developing primacy of reason in Enlightenment values, the madhouse became the preferred method of the treating and safe-keeping of deviant or mentally-diseased community members, quite often women who refused or were incapable of fulfilling their expected social roles. In terms of the development of the psychiatric profession, the cusp of Foucault’s classical age saw the transition of religious fervor in the routing of witches and heretics to the more widely accepted belief in the witch as madperson. Likewise, the shift was not automatic, but rather a progressive shift in attitudes; the belief in witchcraft was not abandoned but rather subverted and appropriated within the new discourse of rationality (Porter, Manacles 16). In this conversion, the witch or heretic becomes the madperson, whose lack of rationality is the primary flaw that required confinement and treatment in the hope of the restoration of reason. 

2Prior to the 17th century, women were liable to be branded and punished as witches for any socially unacceptable acts or peculiar behavior. Through to the early part of the 17th century, European women were one of the ultimate subaltern groups, and were the large social group most frequently persecuted for misdeeds against the Church, a statistic often cited in gender studies on the subject. In her book Women’s Madness: Misogyny or Mental Illness? Jane Ussher states that the medieval witch became the gold standard example for the idea of women as inherently evil and simply another manifestation of widespread misogyny.[2]Although Ussher never cites actual numbers of women prosecuted or killed for witchcraft, she implies that they were by far the highest social group victimized.  Alternate view points importantly take the social and economic standing of the victim (in additional to ethic background) as a primary factor rather than only gender. For further reading on the subject please see Briggs.  She goes on to mention the process of confinement, trial, tortures such as blood-letting, dunking in water, and caning, enforced nudity during bodily searches, and eventual execution (52). One cannot help but recognize the similarities in the process for the routing of witches to the confinement and treatment of the madperson before the development of moral therapy during the 18th century; even the trial, no longer public, could still be seen in the scopophilic display of the madperson during public viewing at Bethlem Hospital. Ussher suggests that the epistemic change witnessed in the late 17th and early 18th centuries which shifted the overt power structure from the Church to Enlightenment values of reason did not in fact change the situation of women, but instead simply altered the form of misogyny. For Ussher, “madness, hysteria or insanity came to replace the catch-all description of ‘witch’ as a label applied to women who were in some way deviant” (60). I would suggest that this change in the root cause of deviance, madness vs. demonic interference, was not as limited to women as Ussher would have us believe. Reason became an inherent virtue, one not limited, though privileged, by men. Unlike the previous centuries, male deviancy became equally punishable through incarceration and/or confinement. The ultimate expression of this change was to appear with Freud’s psychoanalysis in the 19th century where the witch, far from being demonic, is simply a woman who exhibits “unacceptable behavior, illogical behavior founded on a proton psuedos,” or a false foundational belief (Bass 874).

3The initial development of the madhouse trade illustrates this trend toward confining male deviants to the neglect of female confinement. The Act for the More Effectual Punishing such Rogues, Vagabonds, Sturdy Beggars, and Vagrants, and Sending them Whither They Ought to be Sent of 1714 allowed frenzied lunatics to be incarcerated in a “lock-up, bridewell, or house of correction” along with other social disturbers such as those malcontents listed in the Act’s title (Porter, Manacles 7). This act was intended to detain the disturbers of the community in order to maintain social cohesion. As the madhouse trade expanded, so too did the numbers of those confined within public and private madhouses. The beginning of this population explosion of lunacy can be illustrated with the number of confined patients: in 1800 there were only a few thousand people confined for madness, yet by 1900, the number was nearly 100,000 (Porter, Manacles 2). One can assume that by the end of the long 18th century, the number had grown exponentially from the few thousand in 1800. This growth was instigated at the community level rather than at the state level. Indeed, it was not until 1808 that an act was passed to allow local community authorities to found asylums for care of the mad, and it was not until 1845, just after the end of the long 18th century, that Parliament required communities to establish them (Porter, Manacles 117). Thus it was the local communities that drove the move to confine the mad, rather than the authorities, permanently altering the previously established familiar care system. 

Gender and the Development of the Madhouse Trade

4One of the major concepts in Foucault’s History of Sexuality is the imposition of sexuality, and more importantly gender, within the changing microcosm of the family. With the development and preference for the nuclear family as the primary means of the control and correction of deviant sexualities, medical discourse appropriated the concept of moral therapy (110-11). Moral therapy, seen by some scholars as a more damaging and insidious form of oppression than the physical restraint common to the previous centuries, involved shaping the institution of confinement into a replicated family unit, placing the moral authority of the institution with the doctor or father figure. Duties and expectations were then assigned along gender lines. In addition to the influential testimony of the Tuke family in their moral reformation of the York asylum, this moral therapy led to a decrease in the use of physical treatments used in previous centuries (Digby 218). One could assume that the shift in treatment from physical to moral imposition accelerated the confinement of women as many families may have been reluctant to commit their sisters, wives, and mothers because of the physical tortures inflicted upon the mad and the belief in women as inferior men, and therefore less capable of withstanding the physicality of the madhouse. As such, when the treatment styles began to shift to a psychological coercement to reason, we see a noticeable rise in the confinement of women. 

5One cannot take Foucault’s basis for the changing model of the family as the instigator for moral therapy without some critique. Naomi Tadmor suggests instead that 18th-century English society operated within a system of families based on household units which included the nuclear family, in addition to domestics, and non-blood related kin. The significant part of the “family” was that the household unit lived together under the authority of a householder, usually a male (Tadmor 151). However, this was not to prohibit women from the role of authority. The fluidity of households/families included the frequent periodic absence of a male householder due to shortened life expectancy, pandemics, and wars (Tadmor 151). This allowed women to fulfill their duty as householder, enabling them to work without social awkwardness.