Through an exploration of the contents of specific cases, this chapter assesses how claimants, defendants and lawyers in lunacy trials, and Lord Chancellors, occasionally challenged the definitions of insanity embodied in lunacy investigation law. The highlighted cases deal with individuals who, during the course of the trial, were considered to be on the borderlands of madness – that is, they were considered mentally ‘weak’ and/or ‘incapable’, but not necessarily non compos mentis enough to fit neatly into the laws related to commissions of lunacy. The chapter shows how legal struggles around these more ambiguous cases further shaped the definition of madness both inside and outside the courts. The decisions of judicial authority, along with other peculiarities of the chancery court, allowed Lord Chancellors greater latitude for settling cases in lunacy that were at the boundaries of madness. The chapter also emphasises that the commission of lunacy could be a very imprecise instrument that did not always accord with the expectations of judicial authority.
This chapter explains how the book fits into the key debates in the historiography of madness studies. It also explains how the book serves as a useful case study in transatlantic imperialism. The chapter considers the extensive published work by historians on the asylum and the family, exploring its contributions, its analytical strengths and weaknesses and also how more recent research on the asylum has led to a reconsideration of the history of madness in the eighteenth and nineteenth centuries. The chapter then explores a more recent body of work that challenges the centrality of the asylum in studies of madness, emphasising family and community care, the enduring practices of boarding out, home care and myriad local responses prior to and during the growth of asylum provision. Finally, the chapter argues that a transatlantic and legal perspective on the history of madness offers a major contribution to the field of madness studies and the historiographical debates that the field has engendered.
This book reinterprets the history of madness by examining the powerful influence of civil law on understandings of and responses to madness in England and in the North American territory of New Jersey. The influence of civil law on the history of madness has not hitherto been a topic of major academic investigation. Lunacy investigation law (that body of laws encompassing trials in lunacy, chancery court proceedings, proceedings in guardianship and trials of traverse) had its origins in fourteenth-century England. By the eighteenth century, English architects of the civil law had developed a sophisticated legal response to those among the propertied classes who suffered from madness. Lunacy investigation law was also transported successfully along imperial pathways and built into the legal frameworks of several colonies, including New Jersey. In New Jersey a rare and extensive collection of lunacy trials are explored to uncover how customary understandings of and responses to madness were tightly connected to the structures of civil law. The richness of these legal documents allows for an assessment of how civil law, customary responses and institutional alternatives to caring for the mad were balanced in this North American setting before and during the asylum era. Through its analysis of historical precedent, the book also offers insights into on-going contemporary concerns about mental capacity and guardianship.
Lunacy investigation law and the asylum reconsidered
James E. Moran
This chapter probes the relationship between the well-entrenched legal process of lunacy investigation law – along with the customs of community care and understanding that revolved around it – and the lunatic asylum as it emerged as a purpose-built institutional response in New Jersey. This analysis reveals a range of reactions to the asylum from family and community – from outright rejection, to ambivalence, to some sense that treatment there had a positive effect. On the one hand, it is clear from these examples that the asylum was but one of many alternatives in nineteenth-century communities in New Jersey. However, it is also clear that, over the course of the century, especially after the opening of the New Jersey State Lunatic Asylum in 1848, the asylum was an increasingly popular option for those considered to be mad in New Jersey. This ‘warming up’ to the asylum was partly the result of asylum psychiatrists promoting their institutional response as a better bet for the insane and their families. By the mid-1800s, a new hybrid process of lunacy law also facilitated the admission of increasing numbers of patients to the asylum.
This chapter traces the history of lunacy investigation law from 1320 to 1890 in England. This body of law included trials in lunacy, chancery court proceedings, proceedings in guardianship and trials of traverse. Verdicts of non compos mentis in these trials meant that individuals were mentally incapable of managing their person or property. Included in this legal approach to madness was the appointment of a guardian who would oversee the care and management, as well as the material wellbeing, of those deemed to be non compos mentis. The law also provided for the restoration of control over property and person in cases where individuals could successfully convince the courts that they had regained their ability to control property rationally – trials of traverse. This chapter argues that the development of lunacy investigation law for the preservation of property in the face of irrational behaviour was central to the definition of and response to madness for centuries in England. It was a socio-legal context for understanding and responding to madness that would eventually be situated in parallel with laws that signalled a growing emphasis on institutional confinement and inspection in England and, later, in parts of North America.
This chapter evaluates how families used lunacy investigation law as a strategic response to the unsettling circumstances created by the mad behaviour of their relatives. This included the management of the mad and their property, the safeguarding of inheritance and the regulation of marriage. However, the interventions of legal authorities in these trials, along with the competing interests of family members, did not always make the resort to lunacy investigation law as satisfying an option as families often hoped. For their part, the Lord Chancellors considered themselves as the arbiters of this social and economic cohesion, the law of lunacy investigation being an imperfect legal instrument through which they attempted to impose their broad outlook. But these principles were at times inconsistent with the wishes of family members, who often had more specific pecuniary interests in mind. The chapter also shows how lunacy investigation trials highlight the relationships of gender and class in England. Although the law structured family fortunes in gender-specific ways, trials in lunacy highlight how madness could both affirm and complicate conventional relationships between men and women.
This chapter analyses the emergence of clinical and public health concerns with non-infectious disease in Britain during the immediate post-war decades, and examines the implications for the expanding diabetes care team. It suggests that central government’s concern with chronicity during the 1950s and 1960s primarily related to the resource demands of the ‘chronic sick’ – a term used to refer to institutionalised populations of elderly and infirm patients. However, these decades also saw clinicians and public health practitioners begin to discuss chronic illness in new ways and with reference to different demographics. Spurred on by the creation of the NHS and the development of new investigatory techniques, public health doctors and service providers increasingly debated the social, economic, and medical challenges of chronic diseases in younger and middle-aged patients, and experimented with new forms of service organisation. In diabetes, clinics of the 1940s and 1950s responded to a renewed interest in the ‘social’ dimension of care by expanding educative roles for dietitians and nursing staff, and by attaching health visitors and district nurses to their teams. With expanded teams came greater emphasis on bureaucratic co-ordination within the hospital. Eventually, however, resource constraints and rising patient numbers encouraged more radical schemes of GP-based co-ordinated care into the 1960s and 1970s.
This chapter traces the development of standards documents in British diabetes care from the late 1970s to early 1990s. It argues, firstly, that the nature of guidance shifted dramatically over this period, gradually encompassing process and outcome standards, and setting standards for care and audit that encompassed proxies of managerial performance. New instruments thus opened care to external management, and challenged traditional views about clinical decision-making. Secondly, the chapter suggests that the growing role of elite professional and international organisations in guideline creation and audit marked the beginning of a more fundamental shift in the organisation of British medicine, one structured by political, cultural, and social trends but nonetheless driven in part by medical practitioners themselves. Amid decades of academic, popular, and political critique of medical practice and professional accountability, bodies like the Royal Colleges and World Health Organization moved to more tightly manage local practitioners in pursuit of ‘quality’ care. Though not all rank-and-file practitioners supported the proliferation of standards or the increasing role played by elite agencies in their creation and audit, by the early 1990s a growing professional and political consensus was growing around their centrality in securing quality medicine.
This chapter examines the development of new forms of general-practice-based diabetes management over the last quarter of the twentieth century. Although GPs had retained responsibility for ongoing patient care after 1948, the creation of the NHS consolidated the dominant role of the specialist clinic in post-war diabetes management. During the 1970s and 1980s, however, hospital clinicians and GPs began to devise more formal systems of structured and integrated diabetes care, with GPs assuming greater roles in disease management. For clinicians, deputing responsibilities to GPs offered a way to manage patient loads and increasing demands for surveillance in a context of constrained resources, and enabled consultants to refocus on challenging work. For GPs, new forms of care dovetailed with emerging professional projects connected with distinguishing GPs from hospital practitioners and moving GPs into team-based, proactive preventive health work. By the early 1990s, the Royal Colleges, the British Diabetic Association, the Department of Health, and international organisations all supported the increasing role of primary care practitioners in diabetes care. Medical politics, resource distribution, and epistemic change had once again combined to reshape approaches to diabetes management and reposition it as a form of long-term risk prevention.
The Epilogue sets the developments in diabetes management explored over the preceding six chapters against changes in chronic disease care more generally, and considers the story of British professional management in relation to international and present-day comparators. In so doing, it returns to themes and questions laid out in the Introduction, reflecting on diabetes’ historic position as a model chronic condition, considering the post-war changes in medical professionalism, and drawing out the connections between chronic disease and professional management in modern medicine. It concludes with a reflection on the relationship between historians and historical writing, and a consideration of future policy for diabetes care and health services management.