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History of Psychiatry
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Disappointment and Desolation: Women, Doctors and Interpretations of Puerperal Insanity in the Nineteenth Century

Hilary Marland

Centre for the History of Medicine, Department of History, University of Warwick, Coventry CV4 7AL, UK, hilary.marland{at}warwick.ac.uk

Taking case notes as the key source, this paper focuses on the variety of interpretations put forward by doctors to explain the incidence of puerperal insanity in the nineteenth century. It is argued that these went far beyond biological explanations linking female vulnerability to the particular crisis of reproduction. Rather, nineteenth-century physicians were looking at other factors to explain the onset of insanity related to childbirth: stress and environmental factors linked to poverty, family circumstances, poor nutrition, illegitimacy, fear and anxiety, and the strains of becoming a mother. The main focus is on female asylum patients, but all mothers were seen as being susceptible to puerperal insanity.

Key Words: case notes • doctors • families • female patients • history • maternity • poverty • puerperal insanity • 19th century

History of Psychiatry, Vol. 14, No. 3, 303-320 (2003)
DOI: 10.1177/0957154X030143003
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