In 1823, John Haslam, who had been apothecary at the famous Bethlem Royal Hospital, in London, published ‘A Letter to the Right Honourable, the Lord Chancellor, on the Nature and Interpretation of Unsoundness of Mind’, and ‘Imbecility of Intellect’ in which he defined three types of insanity: idiocy, lunacy and unsoundness of mind. This threefold definition was given legal recognition in the important Lunacy Act 1845, the three classes being subsumed under the generic term “non-compos mentis”. An idiot was described as a person “whose mind from his birth by a perpetual infirmity is so deficient as to be incapable of directing him in any matter which requires thought or judgement”. A lunatic was someone who enjoyed lucid intervals and sound memory, but sometimes was non compos mentis. A person of unsound mind was “every person, who, by reason of a morbid condition of intellect is incapable of managing himself and his affairs, not being an idiot or lunatic, or a person merely of weak mind”. Although there was a recognition by the early 1840s of the need for specialist provision for “idiots”, they were still being classed as “insane” in, for instance, Lyttelton Stewart Forbes Winslow’s ‘On Obscure Diseases of the Brain’ in 1860.
I shall be saying more about conceptions of idiocy (or idiotcy) in Chapter I, but the main distinction between idiocy and other types of insanity was that it was a condition from birth and it was a perpetual infirmity. Although the other types of insanity may be the result of heredity, and may in fact show early signs in childhood, they only became established later in life and could, in theory at any rate, be cured. Different types of mental disorder might be classified according to symptoms or causes.
Basing his nosology on symptoms, Jean-Étienne Dominique Esquirol, the influential French physician, recognises four categories in addition to idiocy: “lypemania” or melancholy, “mania”, “dementia” and “monomania”. Monomania, “in which delirium is limited to one or a small number of objects, with excitement, and predominance of a gay, and expansive passion”, was an important addition to the lexicon of madness and became a term that entered the general vocabulary. It describes obsessive behaviour and thinking, such as could be seen in people who were otherwise conducting a normal life, and, since it was also described as “partial insanity”, it raises the endlessly difficult question of the borderline between madness and sanity. Nor is this question evaded in a nosology based on causes. Here, as Jean-Étienne Dominique Esquirol recognises, the situation is complex: “The causes of mental alienation are as numerous, as its forms are varied. They are general or special, physical or moral, primitive or secondary, predisposing or exciting.” They included climate, the seasons, age, sex, temperament, profession and mode of life. I should like to focus particularly on the distinction between physical and moral causes, which was adopted by many clinical writers in their taxonomies of mental disease. Moral causes had to do with the passions, which could be excited by unrequited love, domestic troubles and grief, as well as economic hardship; madness lay in excessive response, in fact, to the trials of life. But the notion of excess already involved an appeal to normative standards and thus undermines any idea of diagnosis as a straightforward assessment of facts. The physical causes listed by early nineteenth-century writers might encompass disease to the brain, but would also include drink, fever, masturbation, injury to the head and even over-study. Moral causes, therefore, did not cover all the behaviour that might have been registered as ethically suspect, but they do incorporate eighteenth-century ideas about the need for passion to be regulated by reason.
The link between madness and morality became still more complex with the introduction of the concept of “moral insanity”. James Prichard is commonly credited as being and indeed was concerned to establish himself as the inventor of this term and with popularising it in his influential ‘Treatise on Insanity’ (1835). In fact, the term was also used by Thomas Mayo in 1835. Thomas Mayo distinguishes moral insanity from intellectual insanity, though he maintains both types of insanity lack the conflict which the sane experience by having standards of judgement: “Many a sane person indeed, may envy the contented and self-satisfied lunatic.” In thus explicitly linking madness and morality, Thomas Mayo recognises the existence in the human mind of a “moral sense” analogous to the “intellectual sense”; it is not the case that insanity simply “unseats the moral principle”. James Prichard’s nosology recognises four types of insanity, three of which constitute “intellectual insanity”, whilst the fourth was designated “moral insanity”, which was defined as “a morbid perversion of the feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the intellect or knowing and reasoning faculties, and particularly without any insane illusion or hallucination”.
Like monomania, this is a partial insanity and by removing from diagnosis the defining necessity of delusion or hallucinations, the idea of moral insanity opens up for medical inspection a range of behaviour that would previously have been subject to official or unofficial moral judgement only. Once again the result is a blurring of the boundaries between diagnosis and judgement. But in any case, the concept of diagnosis implies judgement since it involves the measuring of an individual’s physical or mental state against some standard of health or normality. Where madness was concerned, opinion and practice fluctuated between the appeal to a standard conceived in the abstract, that is, some sort of ideal state, and a standard established through common patterns of behaviour, or an amalgam of these two things. But it was also recognised by some writers (for instance, Lyttelton Stewart Forbes Winslow) that the question of aberrancy concerned only the comparison of an individual’s behaviour and emotional state with what it had been previously. Once it had been accepted by the medical profession, enshrined in law and acknowledged by the public at large that confinement in an institution of one kind or another was the appropriate way of handling madness, the question of diagnosis became crucial, and imaginative literature was not slow in exposing its juridical nature and the difficulties and ambiguities this involved. ‘Hard Cash’ was only one of a rash of novels concerned with wrongful confinement and the correlative problems of diagnosing insanity or defining sanity.
As the first chapter will show, the idea of madness being imprinted on the body, manifest in physiognomy or posture, was widely accepted. That “there is an art to find the mind’s construction in the face” is a tradition going back to Aristotle, as Jenny Bourne Taylor points out in her excellent brief history of nineteenth-century psychology. Sander L. Gilman’s fascinating survey of the visual representations of madness from the Middle Ages to the end of the nineteenth-century traces the shifts in such perceptions and, illustrating the thesis expounded by Ernst Hans Josef Gombrich in ‘Art and Illusion’, explores the degree to which they were influenced by traditional conventions. But, whereas physiognomy conceived of the face and body as the outward expression of internal processes, phrenology, interested in cranial formation, regarding the shape of the skull as indicative of the particular organs it contained. Roger Cooter has isolated four key tenets in phrenology: the brain was seen as the organ of the mind; the brain was a congeries of organs; each cerebral part corresponded to a particular moral or intellectual quality; since the cranium was ossified over the shape of the brain its shape could be used to determine the state of the internal parts. These ideas, which were linked to the physiognomic studies of Johann Kaspar Lavater, whose work will be examined in more detail in Chapter , and originated in the observations of Franz Joseph Gall, were popularised in England by Johann Gaspar Spurzheim and George Combe, and, as Roger Cooter explains, were used to give moral therapy scientific status.
Since mental health, it was thought, depended on the equal development of all the organs of the brain, the treatment for those who showed over- or under-development of one particular faculty was precisely along the lines of contemporary morality: sobriety, chastity, self-improvement and moderation in all things. So, on the one hand, phrenology commandeered the sphere of morality, and on the other hand, it instituted a physiological justification of practices which had previously relied on religious sanctions.
In yet another confusion of the mental and the bodily, the idea of nervous breakdown relied on the structural conception of the body’s nervous system, though there was no clear idea how this worked. Skirting the charge of insanity, psychological symptoms were given greater respectability, for the image of a somatic breakdown absolved the sufferer from moral blame. The terminology might vary: breakdown, shattered nerves, broken health, nervous collapse, exhaustion, prostration, or, towards the end of the century, neurasthenia, could all indicate some sort of mental breakdown. Whatever the terminology used, however, it could be difficult, in fact, to distinguish nervous breakdown from actual insanity; like the partial insanities, monomania and moral insanity, it designated an awkward borderline state.
As Janet Oppenheim shows in her comprehensive book, ‘Shattered Nerves’, although there was a tendency to diagnose nervous breakdown if the patient was middle class and insanity if the patient was working class, in practice such class differentials were not hard and fast. In William Wilkie Collins’ novel ‘Basil’, which I discuss in Chapter , Basil hears himself charged with madness by passing strangers, describes his feverish hallucinations, and is diagnosed as suffering from brain fever. Like nervous breakdown, brain fever was another of those capacious categories in the taxonomies of mental and physical suffering that blurred the boundaries between body and mind. More specific understanding of how the relationship between the brain and the rest of the body developed in the latter decades of the nineteenth-century as the separate discipline of neurology emerged and neurologists such as John Hughlings Jackson and David Ferrier were able to give substance to the tenets of phrenology. The chapter 5 will look at Dracula’s imaginative engagement with David Ferrier’s experiments in cerebral localisation.
By the end of the century phrenology itself had fallen from favour, and doctors who were interested in the mind rather than the brain were anxiously searching for the causes of madness in other ways, though the belief in physical causes of psychological symptoms seemed impossible to avoid. During the latter part of the century, the influence of Darwinism had encouraged belief in the hereditary aspect of madness, and two French writers, Bénédict Augustin Morel and Jacques Moreau, had introduced ideas of degeneracy that were to be taken up by the most influential psychiatrist of the late nineteenth-century, Henry Maudsley, who presented a bleak vision not just of madness, but of life in general. Basing his analysis on an assurance that mental illness had a physical basis as well as being inherited, he saw madness as an inevitable destiny, in which the lunatic, unable to escape the “tyranny of his organization”, was ill-adapted to cope with the harshness of life. Despite his reliance on a somatic aetiology, Maudsley castigated madness as moral degeneracy and projected a gloomy future of racial decline. The opening of ‘The Pathology of Mind’ (1879) incorporates several of the motifs that have already been touched on in this introductory chapter and which will be explored further in the discussions of the novels: “By insanity of mind is meant such derangement of the leading functions of thought, feeling, and will, together or separately, as disable the person from thinking the thoughts, feeling the feelings, and doing the duties of the social body in, for, and by which he lives. Alienated from his normal self and from his kind, he is in the social organisation that which a morbid growth is in the physiological organism: something which, being a law unto itself, in the body but not of it, is an alien there, a morbid kind, and ought in the interests of the whole either to be got rid out of it or sequestrated and rendered harmless in it. However, it has come about, whether by fate or fault, he is now so self-regarding a self as to be incapable of right regard to the not-self; altruism has been swallowed up in a morbid egoism.”
The ideas of alienation and egoism expressed in this extract will be seen to resurface in the discussion of ‘Dracula’, but what I should particularly like to comment on here is the strong moralistic tone, which, by comparing the deranged person with “a morbid growth”, denies him or her the sensibilities of humanity as effectively as the eighteenth-century insistence on the animality of the insane. Henry Maudsley links the mad with the bad: “It is not possible to draw a distinct line of demarcation between insanity and crime […] There are criminals who are madder than bad, insane persons who are more bad than mad,” but in both cases “a man’s nature is essentially a recompense or a retribution”. Like Charles John Huffam Dickens earlier in the period, Henry Maudsley sees the sins of the fathers being visited upon the children, but he promotes a more judgemental attitude by suggesting that a person will not only have a “tendency” to “perform the function pre-ordained in his structure”, but it will also be his “pleasure”. By amalgamating the basic principle of utilitarianism with strict determinism, Henry Maudsley illogically manages to blame people for what they cannot help. The penultimate sentence of his book indicates the pessimism of his thinking: “Nor would the scientific interest of his [a physician’s] studies compensate entirely for the practical uncertainties, since their revelation of the structure of human nature might inspire a doubt whether, notwithstanding impassioned aims, paeans of progress, endless pageants of self-illusions, its capacity of degeneration did not equal, and might someday exceed, its capacity of development.”
Andrew Wynter was obviously indebted to Henry Maudsley’s ideas, but writes in a more humane spirit, concerned to remove the “moral stigma” from madness, but he, too, fosters the fear of inherited insanity; even when it has not become apparent, there are “latent seeds” which only require “some exciting cause to force them into vigorous growth”. Andrew Wynter called his collection of essays published in 1875 ‘The Borderlands of Insanity’, and it might be thought that his concern was with the way sanity can so easily shade into insanity. And in a way it is, but it is not a case of insanity lying in wait for the unwary, something that can happen to anyone, as is recognised by the narrator of ‘Lady Audley’s Secret’: “Who has not been, or is not to be, mad in some lonely hour of life? Who is quite safe from the trembling of the balance?” When this narrator talks about the “the narrow boundary between reason and unreason” she is thinking more democratically than is Andrew Wynter. For the physician, madness does not strike indiscriminately; it is those who are harbouring the latent seeds of madness, those who are hovering in the borderlands, where it is difficult to distinguish true madness from “mere eccentricity” or “moral perversity”, who are in danger of one day becoming insane.
Andrew Wynter conceptualises madness as a “brain disease”, but the “changes that take place are of too delicate a nature for our science to reach in its present condition”, therefore, the physician is driven back on the usual moral treatment in which the true principle of cure and support is “an association with healthy minds”.