The Creation of ‘Disordered Emotion’: Melancholia as Biomedical Disease, c. 1840-1900 Åsa Karolina Jansson Thesis submitted to Queen Mary, University of London, in partial fulfilment of the degree of Doctor of Philosophy Centre for the History of the Emotions School of History 2013 1 Declaration I, Åsa Jansson, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 2 Abstract: This thesis traces the re-conceptualisation of melancholia as a biomedical mental disease in Victorian medicine, with an emphasis on the uptake of physiology into British psychological medicine. Language appropriated from experimental physiology allowed physicians to speak about ‘disordered emotion’ as a physiological process occurring when the brain was subjected to repeated ‘irritation’. When it came to diagnosing asylum patients, however, internal biological explanations of disease were of little use. Instead the focus was on externally observable ‘symptoms’, chiefly ‘depression’, ‘mental pain’, and ‘suicidal tendencies’. The late- nineteenth-century symptomatology of melancholia was in part constituted through statistical practices put in place by the Lunacy Commission, and which emphasised certain symptoms and nosological categories in the diagnosing of asylum patients. At the same time, the symptoms that emerged as defining criteria of melancholia were theorised within a biological explanatory framework. Thus, diagnostic descriptions of melancholia travelled back and forth between the casebook and the textbook, producing a disease concept that on the surface displayed remarkable coherence yet simultaneously spoke volumes about the negotiations that take place when medicine seeks to neatly label and classify the complexities of human life. In sum, this thesis shows how melancholia was constituted as a modern diagnostic category in nineteenth-century British medicine. In doing so, it also tells the story of how ‘disordered emotion’ was made into a possible and plausible medical concept. 3 For Sten Jansson (1948-2005), my constant reminder to remain political. 4 Acknowledgements: I feel very fortunate to have been able not only to undertake a PhD, but to have been given the funding and institutional support necessary to allow me to write the thesis I wanted to write on a fulltime basis. I am grateful, therefore, to the Wellcome Trust for its generous financial support, to the Centre for the History of the Emotions at Queen Mary for providing a stimulating and supportive research environment, and to the QM School of History for the opportunity to gain valuable teaching experience alongside my PhD research. Thanks also to Felicity Callard and Stephen Jacyna for agreeing to examine the thesis. The seeds for this story were planted when I first learnt that history can be an immensely powerful tool with which to critically examine both the past and the present, and thus also for shaping the future. I would especially like to thank Shannon Woodcock and Robert Manne, both of whom (in very different ways) helped open my eyes to the power of historical critique in my final year as an international relations undergraduate student. I’m also grateful to Shannon for an enduring friendship, and most recently for taking the time to read the thesis in its entirety and offer a much-needed non-medical history perspective (and for curbing my abuse of semi-colons!). The idea for this PhD grew out of my first MA dissertation written at the University of Sussex in 2009, and I remain indebted to my supervisor there, Rob Iliffe, for encouragement, arguments, invaluable advice, and for stimulating discussions on the histories of melancholia and of science and medicine more generally. The project began to take shape during the following year while I was reading for the MA at the then Wellcome Trust Centre for the History of Medicine at UCL, and I would particularly like to thank my supervisor at UCL, Sonu Shamdasani, for critical feedback and discussions that were significant in shaping the initial outline of this thesis. At the Centre for the History of the Emotions I want above all to express my profound gratitude to my primary supervisor, Thomas Dixon, for his enthusiasm for this project and unwavering faith in my ability to carry it out, as well as for being a constant source of support, constructive criticism, and encouragement. To walk away from supervisions feeling inspired and energised has been a privilege, and I’ve gained invaluable knowledge about rigorous research and story-telling from our many discussions about writing, language, and precision. I also want to thank Rhodri Hayward, who has repeatedly gone above and beyond the roles of secondary supervisor and head of graduate studies, and to whom I’m grateful not only for continuous advice and support, and comments on draft articles, but also for reading and offering helpful suggestions on the final draft of the thesis. Thanks also to the other members of the Centre steering committee, particularly Tiffany Watt-Smith for helpful advice on many things. Thanks also to Jennifer Wallis, for comments on draft work and chats over coffee about the both frustrating and entertaining world of late-nineteenth-century asylum medicine. I’m also especially grateful to Chris Millard for feedback, support, and innumerable discussions and arguments about every possible aspect of historical research, conversations that were crucial in shaping this project in its early stages, and which continue to inspire me to be a better historian – an aspiration I hope I will never lose sight of. I’m also grateful to be part of a wider network of postgraduate and postdoctoral researchers (partly through the London-based History of Psychiatry Reading Group) with an interest in the psy- and neuro-disciplines. A tremendous 5 thank you first of all to Sarah Chaney, for taking on the time-consuming task of reading the first full draft of the thesis and offering insightful and helpful feedback, and to Tom Quick for valuable comments on a draft chapter. Thanks also to Emily Andrews for fruitful discussions both within and outside of the reading group, and for helpful advice on the classification and treatment of dementia in the nineteenth century. Furthermore, thanks are due to Roger Smith for constructive comments on an early outline of the project. Thanks also to David Lederer, Maria Teresa Brancaccio, and Eric Engstrom for the opportunity to contribute part of my research to a special journal issue on the history of suicide, and I also want to thank Eric for advice on German sources. I’m also grateful to Sarah Chaney and Joanne Ella Parsons for inviting me to speak at the Damaging the Body seminar series in the spring of 2012, and to those attending the talk who offered helpful comments and questions on a paper that came to form the basis for a significant portion of the thesis. I’ve also had the benefit of being able to discuss my research within the forum of the QM postgraduate history seminars (now the Historical Research Forum), and am grateful to the wider postgraduate research community at the QM School of History for stimulating questions and discussions along the way. I’ve made use of a number of archives in the writing of this thesis, and the ability to consult records from several different asylums has been essential in forming a picture of diagnostic practices in late-Victorian Britain. Thanks to the staff at the Cheshire County Archives and the Surrey History Centre, and especially to the efficient and knowledgeable archivists at the Lothian Health Services Archives in Edinburgh. Thanks also to the archivists at the Wellcome Library, where the records of Ticehurst are held, as well as a significant collection of papers from Krafft-Ebing’s practice in Vienna, and to the staff at The National Archives, which hold the records of the Lunacy Commission. Thanks also to the staff at the library of the Royal Society of Medicine, for enabling access to some of the more obscure nineteenth-century British and continental medical journals, and to the archivists at the Senate House Library’s special collections, especially Mura Ghosh for alerting me to the collection of Herbert Spencer papers held there. I would also like to thank the following people for (variably) discussions, advice, arguments, and support (emotional and/or practical) along the way: Melek Cihangir, Lauren Cracknell, Terry Brownlee-Blake, Sophie Bisset, Ingrid Lindstedt, Lars and Aldona Lindstedt, Magnus Vollset, the UCL MA crowd (especially Jenny Adlem, Victoria O’Callaghan, Orla Mulrooney Peressini, Yewande Okuleye, Christopher Sirrs, and Guy Parsons), Roger Cooter, Adam Wilkinson, Michael Gledhill, Maria Bengs, Rebecca ONeal, Emma Sutton, Richard Whatmore, Lizzie Rushton, Anna Broberg, Erin Sullivan, Fay Bound Alberti, Miri Rubin, Elena Carrera, Jane Darcy, and Colin Jones. Finally, to the people without whose unconditional and steadfast love and support I simply wouldn’t have got to this point: Annika Jansson, Annelie Jansson, Britta and Olle Lindstedt, and Anna Wallén – thank you, from the bottom of my heart. 6 Table of Contents Introduction 8 I. From Physiology to Psychopathology: Psychological Reflexion and the Creation of ‘Disordered Emotion’ 50 II. ‘Irritation’ and ‘Mental Depression’: The Emergence of Biomedical Melancholia 81 III. Emotions, Environment, and Equilibrium: Melancholia in an Evolutionary Narrative 112 IV. Statistics, Classification, and ‘Suicidal Tendencies’: The Politics of a Diagnosis 142 V. The Standardisation of Melancholia in Late-Victorian Psychological Medicine 183 VI. Melancholia between the Casebook and the Textbook: Knowledge Production in the Victorian Asylum 216 Conclusion 248 Bibliography 266 7 Introduction Melancholia as ‘Disordered Emotion’: Disease Concepts and the Writing of History If mania and melancholia took on the face that we still recognise today, it is not because we have learnt to ‘open our eyes’ to their real nature during the course of the centuries; and it is not because we have purified our perceptive processes until they became transparent.