“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 individuals. 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.