Why was someone with dementia called a ‘lunatic’?

Many people are surprised and troubled to find that a person with a diagnosis of senile dementia was labelled a ‘lunatic’. But this was actually quite common.

lunatic census

The word lunatic had a legal meaning. Anyone who was admitted to a lunatic asylum was, by definition, a lunatic. And lunatic asylums were often the only institutions which were prepared to accommodate older people with dementia.

The word lunatic conjures up a horrific stereotype of a raving madperson: a term which stigmatises and dehumanises the mentally ill.* But like many such terms which now exist only as unacceptable insults, the word lunatic was widely used in the nineteenth century, as a general word for someone who was insane (another term which has disappeared from official language).

If a person was to be admitted to an asylum, they had to be legally certified as a ‘lunatic’. This certificate was filled in by a doctor, who had to record evidence that the person was really insane. He signed it, usually along with another doctor and a local magistrate. Without this certificate, properly completed, the patient could not be admitted to the asylum. This policy was strictly enforced. No one could be admitted to the asylum without being certified.

So, entering an asylum also involved being legally designated a ‘lunatic’.

This then begs the question: why was someone with ‘senile dementia’ admitted to an asylum?

There were no dementia care homes in the nineteenth century. We can assume that most people living with dementia never entered an institution. They were supported by their families, friends and communities. Unfortunately, without official documentation, it is very hard for us to find out anything about these people.

However, if someone had no family or friends to support them, or if the family didn’t have enough money, time or space to provide that support, then the asylum was one of the only places they could go.

Workhouses provided a certain amount of support for older people who were too poor, or too infirm to look after themselves. But for the most part, workhouse inmates slept on large wards. People who wandered at night, made noise in distress or confusion, or mistakenly got into other people’s beds, were seen as a disruptive presence.

There were also a small number of charitable homes for ‘the aged poor’, but they too were not prepared or able to look after people whose behaviour disrupted the smooth running of the institution.

The asylum was the only public institution which could, and would, take in people whose behaviour made them a disruptive presence elsewhere. In practical terms, this was the very definition of a ‘lunatic’. People with dementia were admitted to the asylum for the same reason as anyone else: their behaviour – usually that which make them a danger to themselves or others, or at the very least an extreme disruption to the lives of those around them – could not be managed by the people they were previously living with or near.

There’s a strong element of unexamined prejudice against mental illness in the shock reaction to people with dementia being labelled lunatics: lunatics are ‘crazy’, but people with dementia are just ‘old’ or ‘ill’. This is underpinned by a seemingly clear distinction in our own culture between ‘mental illness’ and ‘dementia’.

As I discussed in my last post, dementia was very much viewed as a form of insanity in the nineteenth century: a disease which could come on at any age, characterised by progressive mental disintegration, usually brought on by physical or mental exhaustion.

So people with senile dementia were considered to be lunatics 1). Because their condition was explained using the same language and theories as other forms of insanity and 2). Because, when they entered asylums because of their unmanageable behaviour, they had to be legally certified as such.

At the same time, the status of senile dementia as a form of insanity was by no means assured. As the asylums filled up, asylum doctors became more determined to limit the definition of insanity, and thus to limit the number of people entering the asylum. Older people suffering from dementia were particularly unappealing patients: they were seen as incurable, and were often suffering from physical ailments as well as mental ones. Asylum doctors started to argue that ‘the senile’ should be excluded from the asylum because they were not truly insane, but suffering ‘simply from decay of nature‘ (even the cause of a patients disruptive behaviour had never really been a factor in determining whether they were sent to the asylum).

In spite of these objections, there were no genuine attempts to provide more suitable alternative provision for older people with dementia. They continued to be sent to asylums, or remained warehoused on crumbling workhouse infirmary wards, until well into the twentieth century.

*That’s not to say it was a value neutral term: the derogatory and dehumanising usage was also very present in this period.

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4 Responses to Why was someone with dementia called a ‘lunatic’?

  1. Alison C says:

    Very interesting points. It also struck me that the term “asylum” has acquired some negative connotations now that it might not necessarily have had in the 19th century? After all, an asylum is supposed to be a place of safety really. What do you think? I enjoyed the programme by the way!

    • Thanks Alison! The asylum certainly wasn’t lacking in stigma and negative connotations in the nineteenth century – particularly from the 1860s onwards, when the ‘failure’ of the asylums project (ie. The fact that the number of lunatics was going up rather than down) became apparent.

      So it’s not that negative connotations have been recently added, then, but more that the horror-story image of the asylum has ramped up somewhat. This is a lot to do with a desire for superior hindsight – ‘oh, those places were awful, we know so much better now’ – mixed in with a general Jack-the-Ripper-style fear of the Victorian city. There’s also something about the sheer number of people incarcerated, going back to prejudice against the mentally ill: people think that there are people (other people) who ‘should be locked up’, and the idea that people with more ‘minor’ mental illnesses might have once been among them is horrifying.

      The asylum was embedded within Victorian society – it was an important social institution, and people moved in and out of it (much like the workhouse was feared and hated but also met social needs). It definitely did some good to some people (it provided better palliative pain relief, for example, than poor people would receive anywhere else) and was a completely horrifying and damaging experience for others. The case notes, which often include narratives from family members describing what had happened prior to certification, tend to reveal families which had been pushed to breaking point, for whom the asylum represented the least bad option.

      Your question has got me back to thinking about the word lunatic. It’s not accurate to say that these are value-neutral terms (or institutions) which later become insults. The dehumanising (a word which gets bandied about a lot, but is very apt) and othering effect of the word lunatic is part of it from the beginning. Moreover, the designation of that term as a marker of legal differentiation (and physical separation, in the asylum) is an important part of what has made the word lunatic as repulsive as it now seems.

      Although that might seem like an argument against trying to cleanse language of its ill-effects by changing our nomenclature (ie. the suggestion that the term ‘mentally ill person’, or any other supposed euphemism we choose, will come to carry just as much stigma as the word ‘lunatic’), I actually think that trying to use language which upholds the humanity of marginalised people is a worthwhile endeavour. If, by rejecting the word lunatic, we are really rejecting the idea that people in the grips of a psychotic episode (the image I think the word usually conjures up) are thereby separated from the rest of humanity, then it is a very good thing.

  2. Pingback: Whewell’s Gazette: Vol. 11 | Whewell's Ghost

  3. Dr. Andrews, I’d very much like to interview you for the online publication http://www.makingsenseofalzheimers.org Can you please contact me?

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