‘A ghastly absurdity’: The Senility of Dickens’ mother

Elizabeth Dickens (1789-1863) has been named as the primary inspiration for both Mrs Nickelby and Mrs Micawber, fixing her in the popular mind as a flighty and confused woman, with an unending devotion to her financially inept husband.  Dickens’ biographers have been similarly unforgiving, with some recognition of her good nature and cheerful manner.  Dickens (like most people?) had a complicated relationship with his mother.  They were close in some ways, yet it seems he could never forgive her for removing him from school to put him to work in a blacking factory during his youth.1

The adult Dickens financially supported his parents to a large extent, and this continued following Elizabeth’s widowhood in 1851.  Ten years later, when she was 71, it became clear to Dickens that his responsibilities towards his mother would have to extend beyond sending an occasional cheque:

When I got home last night, I found a note from the lady with whom my mother lives, who is terrified by the responsibility of her charge, and absolutely relinquishes it.

Dickens now had to find some new ‘good hands’ to take care of his mother, a task he felt ‘at great loss to settle’.2 A few months later, his brother Alfred died.  Financial responsibility for the widow and her five children fell to Charles, but with it came a solution to the problem of his mother.  Elizabeth was moved in with Helen Dickens, and Helen was paid to nurse and support her until her death.  This was to come only three years later, but in the intervening time, the elder Mrs Dickens was to prove a worrisome charge.  In August 1860, Dickens described his mother’s condition thus:

My mother…is in the strangest state of mind from senile decay: and the impossibility of getting her to understand what is the matter, combined with her desire to be got up in the stables like a female Hamlet, illuminates the dreary scene with a ghastly absurdity that is the chief relief I can find in it.3

 Dickens, now at the height of his fame, had friends in high places.  He engaged William Charles Hood, medical superintendent of the great Bethlehem Hospital (known in the popular imagination as ‘Bedlam’) to treat his mother, lamenting that she was ‘on the whole…rather worse than I had supposed her to be’.4  The doctor’s ministrations did not, apparently, make Elizabeth any easier to deal with, but Dickens did not wish to hear Helen’s complaints on the matter:

I really cannot bear…the strife she gets up in my mind about the whole business.  I was completely disgusted and worn out by her on this last occasion.5

In an earlier letter detailing his mother’s mental ailments, Dickens had concluded that ‘Life is a fight and must be fought out’.6  The end to Elizabeth Dickens’ fight came in September 1863, and was no surprise to Dickens, who felt that she had ‘long been in a terrible state of decay’.7

The case of Dickens’ mother gives me a small, but useful, insight into the management of old-age mental change in the upper echelons of society, something I am finding hard to get a sense of.  The desire to ‘keep it in the family’ prevailed, as was often the case with upper-class mental illnesses, especially at a time when the hereditary nature of insanity was just beginning to gain attention.  The solicitation of advice from Hood adds weight to my argument that ‘senility’ and ‘insanity’ were (<academic caveat> in some ways </academic caveat>) much more closely associated in the nineteenth century than they are today.

 I also see some resonance with the debate over the public responsibility for the ‘senile poor’ in nineteenth century London (probably because that’s what I’ve recently been writing about).  ‘Senile dements’ presented significant challenges for the institutions in which they often ended up – be they workhouses, infirmaries, or lunatic asylums.  The managers of these institutions made no secret of the problems of managing these cases, and clamoured to have them removed.  The ‘senile’ were passed – rhetorically and literally – from institution to institution, and they were only ever admitted begrudgingly.  Elizabeth Dickens’ behaviour clearly posed a huge challenge for those who provided her primary care, and yet the person who bore ultimate responsibility for her – her son – did not want to hear about these practical issues.  He did not want to bear the ‘strife’ it caused him.  Perhaps this is a little unfair to Dickens, whose relationship with his parents was coloured by years of disappointments and difficulties, and whose position as a successful Victorian man precluded him from expectations of taking on that caregiving role himself.  I really need more examples to see how this case fits into the wider picture of upper and middle class responses to the needs of mentally changing aged relatives.  Any leads appreciated!

All letter references are from Graham Storey, Margaret Brown and Kathleen Tillotson (eds.), The Letters of Charles Dickens (Oxford, 1997)

1Fred Kaplan and Norman and Jeanne MacKenzie are quite critical of Elizabeth Dickens’ character and abilities as a mother, and emphasise the coolness of Charles’ attitude towards her.  Peter Ackroyd’s more psychoanalytically inflected biography is rather more forgiving, and describes Dickens’ ‘hopeless love’ for his mother.  Claire Tomalin’s recent biography makes very little reference to Elizabeth.  Norman and Jeanne Mackenzie, Dickens:  A Life (Oxford, 1979), pp. 5, 8, 16, 211, 216, 325; Fred Kaplan, Dickens:  A biography (London, 1988), p. 104; Peter Ackroyd, Dickens (London, 1990), pp. 6-7

2CD to WHW, 28March 1860, vol. ix, p. 227

3CD to FD, 19 August 1860, vol. ix, p. 287

4CD to WCH, 21 June 1860, vol. ix, p. 266

5CD to GH, 24 January 1862, vol. x, p. 22

6 CD to FD, 19 August 1860, vol. ix, p. 287

7CD to EdlR, 13 September 1863, vol. x, p. 288

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Reflections on teaching: before

Tomorrow, I start teaching first year undergraduates.

Teaching is one of the few skills I feel I can legitimately claim to have. As a student, my summer job was teaching EFL to adults at one of the many language schools in Central London. As soon as I graduated I joined the Teach First programme and taught History (among other things) in inner London for two years. Basically, almost all of the paid work I have ever done in my life has been teaching in some form.

But, in spite of all this, I’m feeling quite apprehensive. This is a type of teaching I’ve never done before, with a type of student I’ve never taught before. Should one even call it teaching, or should we call it facilitating – creating the conditions for learning rather than directing it ourselves.

Will the rhetoric of consumption have left students dissatisfied with this model, will they expect to be more passive in the process? I’m used to confronting passive learners but will my strategies for motivation be inappropriate in a university context?

And what about managing behaviour? I know (or hope) I’m not going to have to deal with fights/pen throwing/people cussing each others mums, but what about people answering their phone in seminars, or being persistently late, or not doing any preparation? I know how I’d deal with that in a 13-year-old or a 16-year-old, but I doubt I can use the same techniques with independent adults.

Most of the students to whom I taught history in the school were totally fresh to the subject, and one of my big tasks was to give them confidence in their abilities as historical thinkers. But these students will already have achieved high grades in history, and already have a passion for it – many will already be highly (and rightly) confident in their abilities. How will I manage their expectations of what they can do, and get them to push beyond their successful formulas and try new things?

I spent some time yesterday reading a couple of books on ‘Teaching History at University’. I was a bit disappointed in what I found, just fairly obvious tips like groupwork, debates, and not talking too much. What struck me was how little difference there seemed to be between the advice for university teachers and advice you would find in any book about teaching school students. While I am sure there is a lot of crossover, increasingly so given the growing class sizes in higher education, what really interests me is the difference.

Slipping into ‘teacher mode’ will be tempting, and I think the key to avoiding it is keeping in mind the very different aims of education at school and university level. Of course, the agreed ‘aim’ of a university education is currently in a period of transition. To me, it seems that higher education is less about knowledge, and more about analysis, less about formulas and more about creativity. As your school teacher, you have a right to ask me how to write a good essay; as a university student, the best thing I can do is give you the space and confidence to work it out yourself. For these first year students, it will be the first time in many years they have had the opportunity to learn without life-dependent exams looming at the end of it. This breathing space, and the opportunity it affords to learn more developmentally than formulaically, is one of the best things that a three-year degree can offer.

If this all sounds a bit negative, rest assured, I am incredibly excited about tomorrow and the coming year. Once I’ve taught a couple of seminars, I’m going to post more on my thoughts about the differences between teaching history in the classroom and the seminar room. So for now, wish me luck!

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“Simply from decay of nature”

“These patients are imbecile simply from decay of nature, and quiet in manners, and should, in the opinion of the committee, have been allowed to spend the little time left for them in the respective Workhouses, without compelling them to run the risk attending the journey to Caterham.”

- Report from the Committee for Caterham Asylum, sent to the Metropolitan Asylums District, 9th December 1871

This is taken from a report written by the Governors of Caterham Asylum in 1871.  Caterham had been opened a year earlier in an attempt to relieve the burden on the main county lunatic asylums by taking on some of the ‘incurable’ cases who were thought to be unsuitable for mainstream asylum care.  Its main purpose was supposedly to manage and train people diagnosed as ‘idiots’ (broadly, people who were thought unable to learn or process information properly, but who were not deluded or violent).

Training the inmates, producing useful members of society, and maintaining an orderly and efficient institution were the key aims of the Caterham governors.  They were, however, confounded by the number of elderly and infirm cases sent to them from workhouses across London.  Such people were not only unsuitable for training and education, but needed a level of care and attention which the asylum was not able (or prepared) to provide.

This was a problem in most, if not all, lunatic asylums, but Caterham was particularly vocal in its objections.  The quotation above is one example of the many passive-aggressive appeals made to the powers-that-be to admonish the individual Poor Law Unions who acted in this way.

Caterham administrative block, c.1914Caterham administrative block, c.1914.
© Peter Higginbotham

Often, objections were raised on the grounds of  the physical condition of the patients when they arrived at the asylum – clearly unfit for travel (quite an ordeal in mid-Victorian London, even across short distances) and so affected by the journey that they died shortly afterwards.  In this example, the dignity of the patient is also invoked, asking that they be allowed to “spend the little time left for them” in the Workhouse, without suffering the stigma of asylum admittance.  However, I cannot help but feel that these reasons were used by the asylum to make their argument more compelling, and that the heart of their objection is that they felt that these cases simply did not belong in their institution.

The problem was, of course, that such cases did not really belong anywhere.  As the nineteenth-century wore on, only the very toughest proponents of the doctrine of less eligibility (the idea that conditions for those receiving poor relief should be worse than the worst possible existence without poor relief) thought that those impoverished through old age belonged in the workhouse.

The governors of Caterham, like those in charge of most asylums at this time, felt that the aged did not belong in their institution because they were not really insane, they were not really ill, they were simply showing signs of the inevitable decay from advanced age.  Calls to remove the elderly from the asylum for this reason grew louder as the century wore on, and as asylum physicians were faced with increasingly crowded institutions which seemed far removed from the therapeutic ‘utopias’ they were originally conceived as.  One of the contentions of my thesis is that these practical considerations – the need for a manageable asylum population and the desire to show that they had the power to cure – played a role in changing medical conceptions of mental change in old age.

‘Senile insanity’, ‘senile dementia’, and a host of other old-age mental illnesses were described in books and articles about diseases of the mind, alongside other forms of insanity.  Such cases were sent to asylums by their families, and admitted to asylums by doctors.  Yet, as the consequences of public institutional care of ‘lunatics’ became apparent, the definition of what constituted ‘lunacy’ came to be more tightly defined.  These elderly cases were no longer suffering from ‘senile insanity’, an organic disease of the brain, but ‘simply from decay of nature’.

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Today’s tweet 5/4/11

“Senile insanity due to atrophy of the brain, or exaggerated dotage, is, I feel sure, far more common than it once was.”

This was said by the great Victorian psychiatrist James Crichton Browne in 1891, in an address to students of the medical school at Leeds. Unlike many similar comments which are made today, this was not spurred by concerns about the rising number of elderly people. In fact, Crichton Browne was worried about falling numbers of elderly people. He claimed that every age group in society was benefitting from the fall in mortality rates caused by improving sanitation and health, except[it] the oldest; the over-65s. A smaller proportion of people, he suggested, were reaching an advanced age than had done 50 years before.

Much like twenty-first century commentators, Crichton Browne thought that old age was increasing in length: but at the other end. ‘Premature senility’ (people ‘growing old’ at younger and younger chronological ages) was his primary concern. ‘Modern life’, in particular the life of affluent, successful, urban men, was commonly blamed by Victorians for almost any evil they encountered, and Crichton-Browne invoked it to explain his crisis of ageing. The ‘high pressure existence’ to which the urban population were subjected, he suggested, literally wore people out in both body and mind. ‘Social Darwinism’, the idea that only the fittest can and should survive in society, was very much in the air, and Crichton Browne did not like it: ‘the competitive dispensation under which we live’, he wrote, was present from earliest childhood, and it was thus in ‘the nursery’ that the eventual degeneration of the elderly mind began.

While this might seem like a very negative attitude, Crichton Browne was in fact attempting to counter the negativity which he felt this struggle for survival had engendered. If human activity was causing people to age too soon, then regulating this activity could preserve the body and mind far beyond current expectations. Like most of his contemporaries, Crichton-Browne believed that ‘it is in the autumn of life that wild oats ripen and come to fruition’. In other words, if someone lives a life of excess (in work and in pleasure) they can expect to suffer the consequences of that lifestyle in a decrepit old age – unless they have a handy portrait in the attic, of course. Moderation, variety and temperance (though not necessarily total abstention) were recommended by a wide variety of Victorian authorities, from the religious to the financial to the medical, as the keys to a long, healthy and happy life. This doctrine of self-control and self-determination, told that the individual could, through their own efforts, control their destiny, both in this life and the next.

In some cases this led to a surprisingly optimistic and upbeat portrayal of the ageing process. While great longevity is a cause of concern in the twenty-first century, 100 years ago it was thought that a trend of more people living longer would also see a great improvement in the health of the elderly, and was therefore nothing to fear. Crichton Browne insisted that it was realistic for the students he was lecturing to see their patients live to 100 healthy years, and that they should also accept nothing else for themselves. While this might seem naively optimistic, Crichton Browne himself lived in reasonably good health all the way until his death at 98. Maybe he was on to something after all….

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Today’s tweet 8/3/11

“On the 12th Sept she went for a walk. She went to the House of Lords and demanded admission.”

This is from the case notes of Mary Warren, a 66-year old former servant, who was admitted to Hanwell lunatic asylum on the outskirts of London in September 1891. She had been picked up by the local constabulary and taken to Fulham workhouse, where she was certified insane and sent to Hanwell. It was not the first time she had been committed. 11 years before, according to the niece who was called on to give an account of her, she had spent over three years in an asylum in Devon. Apparently the intervening decade was not passed in absolute health: “Although she was discharged recovered, the informant says she has always had strange delusions but was easily managed.” Those delusions included the belief that she was very wealthy, that she was only half her age, and that she had seen ghosts rise from the ground in front of the house of commons.

Asylum case notes are a wonderfully rich source, which has been mined extensively by historians trying to get close to ‘the patient’. Although the accounts are mediated by the doctors who recorded them, these records give us an opportunity to get detailed insights into the lives of individual sufferers. Hanwell insisted on gathering, from family members or close friends, narratives on the patients’ lives up to then, and of their descent into illness. This did not mean that the families were automatically accorded respect as interpreters of the case: this doctor noted, “Informant is a silly simpering imbecile.”

The doctors at Hanwell diagnosed Mary with ‘senile dementia’. Their description of her condition contains many of the phrases common to cases of dementia, and which – though devoid of the tact and respect which we now rightly demand – are recognisable to us as elements of dementia: “Memory impaired. Is simple, childish, demented… Becomes very incoherent in prolonged conversation.” Yet other elements of her case do not seem so well to fit that brief, such as visions of people rising from the grave, and auditory hallucinations of “wonderful and difficult sayings by night and day”. She has spent many years experiencing phenomena which we would now consider akin to the symptoms of schizophrenia. So why were her doctors so sure that this was a case of “senile dementia”, something which we now associate primarily with memory loss and its consequences, and more importantly, with the organic changes in the aging brain?

I came across Mary Warren’s case very early on in my study of the history of old-age mental health, and it was one of the first things which alerted me to the fundamental differences between nineteenth and twentieth century conceptions of old-age mental illness. The nature of that difference is something I feel I am yet to have a satisfactory understanding of, although I have plenty of ideas. Maybe, as time goes on, I may feel confident enough in them to share them with you.

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Today’s tweet 10/3/11

“One has to just – I don’t know myself – I don’t know at all – oh goodness gracious, what is it all?”

This was spoken by a woman called Auguste D during an interview with a doctor at the Frankfurt lunatic asylum in 1901. They were recorded in her case notes, which still survive. The doctor’s name was Alois Alzheimer, and he was rather puzzled by Auguste’s case. She was presenting symptoms of memory loss and confusion, as well as agitation and delusions – her first symptom was reported to be irrational jealousy of her husband. He had seen such symptoms before, he thought, in cases of senile dementia, but not with such severity, nor in someone so young (Auguste was in her mid-50s).

When Auguste died, Alzheimer had already moved across the country to another job, but he sent for her brain so that he could dissect and analyse it. Using the latest microscopy and staining techniques he found, he thought, a new configuration of pathological lesions: “neurofibrillary plaques and tangles” were both present in Auguste’s brain and remain to this day the neuropathological hallmarks of the disease which was to bear his name. In 1910, just four years after Alzheimer had published the case of Auguste D, and when less than a dozen similar cases had been identified, the great psychiatric theorist Emil Kraepelin announced that a new disease had been discovered: Alzheimer’s disease.

There are many different ways to tell the story of the genesis of Alzheimer’s disease – the one recounted above is just one of them. Why I chose today’s quote was not so that I could get into the question of how Alzheimer’s disease came to be, but because I always find reading Auguste D’s case notes quite an emotional experience. As a historian of mental health, I think that the way that we understand and even experience mental illness is very much influenced by the context we are in. I have some sympathy with the idea that no one suffered from Alzheimer’s disease before 1910 because such a thing did not exist. However, when reading first-person narratives of mental illness, whether by a sufferer or an observer, I sometimes come across things which seem so instantly familiar, which speak so directly to my own experiences with mental illness, that they seem to suggest eternal, universal forms of human suffering. I don’t think the two approaches are irreconcilable. We can be aware of how strongly the ideas which surround us shape our lives and our understandings of ourselves, while still allowing for the possibility that sometimes an experience or a story will reach across that historical language barrier. History, and perhaps the history of medicine in particular, has more than one job to do: the analytical task of showing how different categories and concepts came to be formed and accepted, but also a more humanistic task of connecting people with their ‘emotional ancestors’, and reminding them that, in their experiences of suffering and tragedy, they have never been alone.

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Today’s tweet 8/3/11

“Why, I’ve been sitting here for five years, and I shall sit on here to the end. I’m just waiting you see. We’re all just waiting.”

From an article called ‘In the Day-Room of a London Workhouse’ by Edith Sellers, published in “Nineteenth Century and After: a monthly review” in September 1902.

This was said by one of the elderly inmates of a “Great London Workhouse” (the author declines to tell us which one) which Edith Sellers visited as part of her Europe-wide investigation of different systems of caring for the poor and aged. This woman was one of the 20,000 over-65s living in London workhouses at the time, a number that was much higher than in the rest of the country, although it was by no means rare to see an older face in the workhouse throughout the nineteenth century. They found their way there through the reluctance of London Unions to pay outdoor relief even to the very old, and through a general culture of poverty, mortality and high rents that left few families able to afford to support anyone too old or infirm to work – if the elderly person in question even had any family left alive in the first place.

Sellar’s piece is a damning indictment of the conditions of the elderly in the workhouse. It is littered with poignant statements from the inmates like the one above, such as a man who noted pointedly that he was just “killing time”, and another who told Sellers: “I had to choose between the workhouse and starvation, you see, and – I chose badly.”

She makes little mention of the mental state or mental infirmities of the people she talks to (or lack thereof); although the overall atmosphere is one of dejection but resignation. We know that there were older people with chronic mental infirmities living in workhouses, and many asylum superintendents felt that that was where they should stay. Seller’s sympathies, it seems, were not with such people: she pitied those who must pass their days “elbow to elbow with a jabbering idiot”. More insightful or engaged pictures of the experiences of the elderly mentally ill in the workhouse, I have yet to find.

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