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Inheritance, neurasthenia, criminals, and GPI
Amy Milne-Smith

This final chapter explores why madness could evoke so much social anxiety. Fears of perceived rising lunacy rates were used as proof of over-civilization and decline. As the nineteenth century progressed, cure rates seemed to plummet, and degeneration literature flourished. Fear that madness was hereditary led to gloomy predictions about the decline of the British race paralleling conversations about urban decay and criminal classes. This chapter places medical conversations into broader cultural contexts.

Particular masculine anxieties were linked to fears of overwork and the emasculated neurasthenic, the criminalized degenerate, and the alcoholic madman. A final focus on the diagnosis of General Paralysis of the Insane demonstrates the social construction of medical thinking. GPI was one of the few mental diseases that could be seen in the brain after death, and it had a relatively clear and consistent set of symptoms. Despite this, GPI was often diagnosed through lifestyle as much as symptomology. The fact that GPI seemed to affect men more than women and led to almost inevitable death made it the embodiment of degenerationist fantasies that only increased as the century progressed. Insanity was a central point of argument in theories of decline.

in Out of his mind
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Amy Milne-Smith

The final section of the book points to the significance of Edwardian thinking going into the twentieth century. The doctors deployed to treat soldiers in the First World War were largely trained in an Edwardian and Victorian medical world, and thus their understanding of men’s madness is the missing link to most studies of shell shock. This epilogue highlights the continuity of concerns over men and mental illness into the twentieth century.

in Out of his mind
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Madmen in the attic?
Amy Milne-Smith

This introduction outlines the scope of the book, its methodology and approach, and gives a brief discussion of historiography. The text sketches in broad strokes what examining the experience and representation of madness tells us about Victorian masculinity. This includes a study of sufferers, families, and the culture at large. It argues that the social, medical, and personal explanations of men’s insanity point to increasing anxieties about manhood and civilization in general over the course of the second half of the nineteenth century.

in Out of his mind
Reputation, rage, and liberty
Amy Milne-Smith

This chapter continues with the voice of the patient, but rather than focusing on those who were ashamed of their fate, here the patients fought back. Individuals and advocacy groups challenged diagnoses both inside and outside the asylum. This chapter explores how men fought back against certification and incarceration and attempted to restore their public reputations or regain their freedom. The chapter outlines the boundaries of madness, and the debate over the line between eccentricity and madness.

Here Chancery lunacy cases take centre stage, widely publicized in the press as men of wealth and position battled to prove their sanity. Such situations were the worst-case scenarios for families of status and influence and demonstrate a complete breakdown in family coherence. The chapter ends with a series of case studies which played out in the public eye, exploring how and why different men challenged their diagnoses. Men’s chief justification for telling their stories can be grouped into three main motivations: an attempt to reassert their patriarchal control, an attempt to regain their freedom, and a desire to restore their reputation.

in Out of his mind
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Stories of violence, danger, and men out of control
Amy Milne-Smith

This chapter places media representations of madness as its central focus. Stories of madmen as perpetrators of violence made for sensational copy, and thus they are overrepresented in media coverage. These narratives reveal larger anxieties of the modern age, and the fragility of established rules and norms of society. The fear that madness could strike at any moment, and that a man could suddenly fall victim to an irrational and violent breakdown, was particularly gendered as male. Madwomen were often portrayed as victims whereas madmen were often portrayed as perpetrators of violence, both within the home and within the asylum. These media panics are perhaps the most public expressions of underlying anxieties about the threat that madness posed to everyday people and highlight the deep stigmas of men’s mental illness.

In assessing media trends, clear gender- and class-based panics emerge. In particular, the figure of the working-class madman who murders his family highlights fears of domestic instability. And stories of sudden madness emphasized deeper fears about the state of British manhood and the dangers of modern technology.

in Out of his mind
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The asylum
Amy Milne-Smith

The second half of the nineteenth century saw the establishment of a national network of asylums across Britain. Asylums were sites of both enormous hope and dashed expectations. This chapter explores why some people embraced institutionalization, and why others did not. It gives readers a brief overview of the structures of asylums, rules of admission for different classes, and types of conditions, and builds on the strong institutional histories of asylums. It provides information about the diversity of asylum experiences, from the elite institutions for the wealthy, to the mass pauper asylums, to the criminal asylum.

The Victorian asylum was born out of optimism, flourished in an era of no better alternatives, and quickly became a symbol of failed expectations. I focus on the male experience of incarceration, and how this experience was particularly destabilizing for those used to being in control of themselves and their families. Men also proved particularly difficult patients to control if they were prone to violence. This chapter introduces the typical experience of madness in the Victorian era that saw the asylum as at least a part of most men’s curative treatment.

in Out of his mind
Home care, doctors' care, and travellers
Amy Milne-Smith

While some families hid their family members away in dark corners, victims of neglect and cruelty, others kept loved ones at home under expert care and keen attendance. This chapter explores men who were treated at home, sent to travel, or lived in the community. Diversity is underscored both in patient experiences and the reasons for choices of treatment. I emphasize the complex negotiations between patients, doctors, and families in decisions of care.

While many madmen likely left no trace in the historical archive, there are many examples when single care went wrong, and families were forced to admit to authorities that they needed help. This includes men at all income levels. Case studies highlight the complex family dramas involved when a man of wealth and power refused treatment and would not be restrained. This chapter also explores the abuse that patients suffered outside of official legislation and sometimes within their own homes.

in Out of his mind
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Masculinity and mental illness in Victorian Britain
Author: Amy Milne-Smith

Out of his Mind is a study of the consequences of a diagnosis of insanity for men, their families, their friends, and the culture at large.

Studying the madman allows for an exploration of the cultural expectations of male behaviour, how men responded to those norms in their lived experiences, and what defined the bare minimums of acceptable male behaviour. Men’s authority in society was rooted in control over dependants within their household and beyond; without that power, the foundation of their manhood was in question. As such, madness touched on a key tenet of nineteenth-century masculinity: control. Building on accounts from sufferers, doctors, government officials, journalists, and novelists, Out of his Mind offers insight into the shifting anxieties surrounding men in mental distress. Exploring everything from wrongful confinement panics, to cultures of shame and stigma, to fears of degeneration, this study makes an important contribution to histories of gender and medicine.

This text puts the madman at the centre of the history of Victorian masculinity and helps us better understand the stigma of men’s mental illness that continues to this day.

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Failures of morality and the will
Amy Milne-Smith

This chapter puts the patient at the forefront of analysis and is deeply influenced by recent trends in the history of emotions to interrogate shame and stigma. The value-laden diagnostic system of Victorian lunacy meant that patients were often held responsible for their own breakdowns. Without a thorough understanding of the causes of mental illness, ‘intemperance’ was often used as a cover for any disease doctors believed was self-inflicted. Both patients and their families were well aware that men could be blamed for their mental breakdown, leading to shame and secrecy.

This chapter outlines the intellectual framework of this culture of shame, and how patients struggled within this context. The ideal late Victorian man was above all things in control of himself and his place in the world. A man who lost control of his mind and his emotions struggled to retain his sense of manhood. When men felt culpable for that loss, their shame added an extra layer of humiliation. In particular, when a man’s madness was associated with alcohol or sex, internal and external pressures of shame intensified. Often patients were hardest on themselves, and doctors feared that guilt over sexual indiscretions could be more damaging than the sexual habit itself. Chapter sources include memoirs and case notes to find the voices of the patients, along with medical texts and fiction to get a sense of the broader popular and medical contexts of the issues.

in Out of his mind
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Dolto in the twenty-first century
Richard Bates

This concluding chapter tackles the question of Dolto’s twenty-first-century reputation and what France is to do with her legacy.

Considering various references to Dolto in intellectual and popular culture, it shows that after 2000, she was no longer seen as a unifying national expert, but rather as someone linked to a particular ideological outlook, whose ideas were a suitable subject for mockery. Efforts to continue her agenda by her daughter or the politician Edwige Antier, or by opponents of equal marriage legislation, demonstrate that Dolto’s thinking became a polarising rather than a unifying force.

The chapter also shows how, towards the end of her life in the 1980s, Dolto was disconcerted by an increased focus on the psychology of race and empire in France’s former colonies, and unable to adapt her ideas to this development.

As Dolto’s life recedes into history, it becomes easier to see her ideas as products of a particular set of historical circumstances, rather than – as she and her followers believed – timeless truths about the human condition. While there are good reasons for wishing to retain some of Dolto’s contribution, it is doubtful that the ongoing desire to celebrate the positive aspects of her interventions can withstand the increasing criticism of the problematic and outdated aspects of her ideas.

in Psychoanalysis and the family in twentieth-century France