Abstract
Since the 1980s there has been an efflorescence of scholarship on death, dissection, burial and mourning in past societies (Gittings, 1984; Gordon and Marshall, 2000; Houlbrooke, 1998; Jalland, 1996; Jupp and Howarth, 1997). By comparison, historians have little explored how earlier populations dealt with the deceased insane. Asylum histories which do address insane mortality gravitate towards epidemiological approaches, foregrounding quantitative analysis (Digby, 1985; Mackenzie, 1992). Accomplished work on death rates and causes has compared asylums in different geographical regions and/or drawn contrasts over time across sexes, classes and diagnostic categories (Melling and Forsythe, 1999, 2006; Porter and Wright, 2003). A minority of international studies more substantially examine lunatic mortalities, corpse examination/disposal and memorialization (Colebourne, 2010; Reaume, 2000). There has also been a recent outcrop of historical bio-archaeologies on asylum deaths (e.g. Rogers et al., 2006). Yet scholarship has generally neglected the wider medical, social and ethico-cultural meaning of such phenomena. Cross-national (let alone cross-cultural) comparison has been lacking, and research on death and madness has not until now been consolidated in a single edited collection.
Some articles in this Special Issue entail more geographically specific studies (Black and Boulton on London; Michael and Hirst on Denbigh), while others provide broader national (Houston, on Scotland; Hurren, C Smith, L Smith on England), or supra-national surveys (Marland on England and Scotland; Andrews, Philo on England, Wales and Scotland). Embracing a longue-durée chronology but concentrating on Britain (rather than on wider international contexts) has permitted a coherent and congruent geographical and thematic compass across time
While (pace Arieno, 1989) contributors’ concerns reside outside traditional historical demography/epidemiology, some (Boulton and Black, C Smith, L Smith) concentrate more on debates and data about causes and rates of mortality. They underline institutional authorities’ propensity to blame mortality on families and patients themselves, whether implicating delayed, moribund admissions or sufferers’ degenerate constitutions and insalubrious lives. A number explore how far lunacy was understood as a primary/contributory cause of mortality, or contrariwise as of negligible relevance to the corporeal distempers found to explicate many deaths. Most address medical contentions regarding how far and why insanity killed, some stressing how mortality statistics increasingly came to serve critics rather than advocates of asylumdom. Expectations of cure and lowering death rates justified post-1808 expansion of the asylum system; vice versa, high or unchanging death rates subsequently signified failure. Medico-psychological onus on a range of (contested) ‘accidental’ aetiologies is discussed, in particular infectious, pulmonary, visceral and diarrhoeal diseases, but also mortalities increasingly linked to brain and neurological diseases.
Houston’s study highlights social selectivity in regarding Scottish suicide as an outcome of madness, and suicide’s enduring denigration and sensationalizing (also, Houston, 2010). While only his paper deals exclusively with suicide, others address aspects of such ‘sad histories’ (Marland, Michael and Hirst, L Smith). Boulton and Black’s emphasis on how few suicides were registered as insane in contemporary English records echoes Houston’s findings for Scotland where most self-murders were ascribed to culpable moral rather than exculpatory mental pathology.
Papers examining burial and mortuary practices/sites underline the darker sides of disposal. Hurren and Andrews delineate exploitation of patient deaths and autopsies for the ‘higher’ scientific goals of Victorian/Edwardian mental medicine. Hurren stresses the large-scale ‘backdoor’ medico-anatomical trade in pauper lunatic corpses in Birmingham, Cambridge and Oxford, and its primary rationales. She points to impoverished families’ loss of control of corpses, and the often undignified burials of the anatomized. Andrews discusses deceased patients’ conversion into post-mortem artefacts, charting analogous anatomical traffic with Edinburgh schools, but accenting the (significant) minority subjected to double-anatomizing and dehumanized interment.
Philo’s geospatial study of burial practices underscores the lunatic dead’s common marginalizing, resonating with Andrews’ spatial analysis of asylum dead-houses/mortuaries. Yet Philo (also Michael and Hirst) concurrently elucidates competing contemporary views concerning off- versus on-site burial. Objections to lunatics silting up parochial graveyards confronted moral arguments against segregating the insane in ‘obscure’ corners in death as well as life. Medico-moral concerns about sanitation and insulating patients from depressing sights of burial/dissection vied with managerial and economic concerns about control of corpses (Philo; also Andrews, Hurren).
Countering onus on anonymity and objectivizing of deceased lunatics, contributors assert variability in experiences and maintenance of positive rituals of earthly departure. Michael and Hirst’s survey of Denbigh asylum discusses death less as a medical than as a religio-moral and socio-communal event (also Houston). They suggest superior decencies in asylum burial services compared with some pauper burials, including frequent participation of parish officers, family members and asylum staff. Denominational representatives fulfilled vital roles mediating at sick-/death-beds and at subsequent burials/funerals (also, Walsh, 1999). Particular attendants performed special burial/dissection-related duties; selected patients occasionally tended the deceased and made coffins. Michael and Hirst (pace Hurren, Andrews) spotlight minimal dissections and enduring rudimentary conditions for pathological research at such provincial asylums. Large proportions of the deceased were reclaimed and decently interred; vigorous objections were raised to indelicate pauper disposals (Andrews, Hurren, Philo). Sentiment informing both burial arrangements and the anatomical gaze was conditioned, however, by ‘publicity’, economic utility and clinico-pathology’s epistemological priorities.
This volume is also about the experience of death (Andrews, Houston, Marland, Michael and Hirst). Analysing death among women diagnosed with puerperal/lactational insanity, Marland most concertedly of all explores patients’ morbid thought-worlds (also Marland, 2004). She highlights clinical association of childbirth traumas with patients’ common fears of impending death and damnation, and with infanticidal/suicidal impulses, puerperal insanity being cast as embodying ‘mortal risk’ or as death’s ‘harbinger’. Andrews likewise refers to inflection of patient commentary by anxieties around mortality and burial/dissection, and by macabre and disarming graveyard humour. Such research raises important questions. To what extent and why were certain forms of insanity regarded as pathologically more prone to morbid agonizing? Did particular features of confinement or patient life-histories encourage fixation on mortality?
This volume consciously engages in respectful excavation of ‘silenced’ stories, re-contextualizing the ‘lost’ dead. It signals how prevailing social stigmas, ethical inconsistencies and asylumdom’s compromised managerial ethos resulted in abuse/‘disappearance’ of the deceased, also highlighting patient and wider-relational dissent. Our historical recovery echoes recent endeavours by modern communities of survivors, relatives and mental health professionals to re-identify and restore the grave sites and biographies of the ‘forgotten’ mentally ill (Philo; see also websites listed).