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Diagnosing mental illness in the Edwardian era

The fourth and current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders ('DSM') list 297 disorders or diagnoses. A fifth edition is in preparation.

A history of classifying mental illness

The history of psychiatric pathological classification is controversial and contested. The most dramatic visual statement of its pre-history on this side of the Atlantic must be Caius Gabriel Cibber’s statues of ‘Raving and Melancholy Madness’, which once dominated the entrance to Bethlem Hospital and constituted part of the iconography of the city of London, and are now on display in the Archives & Museum.

‘Mania’ and ‘melancholia’ were the two syndromes rendered in Portland stone by this ‘DSM-1676’.

A more elaborate, and more recent, diagnostic effort is represented by the Schedule of Forms of Insanity first issued by the Lunacy Commissioners (later the Board of Control) in 1907. The Lunacy Commissioners governed admission to and conditions within the asylums of England and Wales by a system of regulation, inspection and tribunal, and published annual reports containing reports and statistics on mental health.

Recording diagnoses in Edwardian hospitals

From 1907, the Commissioners required asylums to record diagnostic details in conformity with their Schedule. (Parallel developments in the United States of America are described in the introduction to DSM-IV TR.) Register entries on ‘manic’ patients were coded II.8 a. b or c (a for recent, b for chronic, c for recurrent) thereafter. Entries on patients suffering ‘general paralysis of the insane’ were coded II.2. And so on.

Without the codes in the Schedule, some of the details given in the asylum registers of the early twentieth century are difficult, if not impossible, to interpret.

Now that these codes (and a number of the asylum registers in which they were used) are over one hundred years old, the Health Archives and Records Group of the UK and Ireland have published a version of the Schedule online.

This publication opens a window not only onto asylum register data, but also onto the theory and practice of psychiatric diagnosis in the Edwardian era.