" In her Vapours…[or] indeed in her Madness"? Mrs Clerke's case: An early eighteenth century psychiatric controversy. (original) (raw)

1990, History of Psychiatry

Pnnted m England l~agued by difficulties in defining mental illness, yet required to impose its diagnoses and treatments on patients, psychiatry has inevitably, throughout its history, come into repeated conflict with the rights of its patients, the interests of their families and with itself. During what Roy Porter has termed 'the long eighteenth century',1 controversies over the alleged abuse of psychiatric authority reached a new pitch. Protests multiplied as, partaking of an eighteenth century 'consumer boom', unregulated private madhouses sprang up in abundance, and threw into sharper relief what had always been an uneasy marriage between the 'expertise' of medical practitioners and lay proprietors, and the needs of the insane and their families. Moreover, as old humoural models receded in the face of new mechanical and iatrochemical interpretations of diseases, diagnostics and the very language of mental illness widened into an acute state of flux. Early eighteenth century physicians observed how over the years of their practices, Melancholy had merged into Vapours, Hyp into Spleen, and thenceforth into further sub-divisions; whilst nervous complaints were themselves acknowledged as attenuated forms of insanity. By mid-century, one common ground between specialists was that madness had never been 'precisely defined' and comprised not one but many species of disorder.' As nervous illness became increasingly fashionable amongst the upper echelons of society, the Augustan moralists drew a fearful picture of a land ruled by the goddess Spleen, where 'each new night dress' spawned 'a new disease' . They denounced 'such Maladies' as mere sham, vanity, pride, delusion, or madness itself and dismissed the mechanical explanations of