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Diagnosing MaDness
stuDies in RhetoRic/coMMunication
Thomas W. Benson, Series Editor
Diagnosing Madness
the DiscuRsive constRuction
o f t h e P s y c h i at R i c Pat i e n t ,
1850–1920

Cristina Hanganu-Bresch
& Carol Berkenkotter
© 2019 University of South Carolina

Published by the University of South Carolina Press

Columbia, South Carolina 29208

www.sc.edu/uscpress

28 27 26 25 24 23 22 21 20 19
10 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

can be found at http://catalog.loc.gov/.

ISBN 978-1-64336-025-6 (hardback)

ISBN 978-1-64336-026-3 (ebook)

Front cover design by Brock Henderson

To my parents, Marius and Doina, to whom I owe everything,
and Art, who believed in me when it mattered,
Cristina Hanganu-Bresch
“Madness is a foreign country.”
Roy Porter, A Social History of Madness, 1987

“The right to restrain an insane person of his liberty is found in that

great law of humanity which makes it necessary to confine those
whose going at large would be dangerous to himself or others.”
Chief Justice Lemuel Shaw, Matter of Oakes, 1845
contents

l i s t o f i l l u s t r a t i o n s viii
s e r i e s e d i t o r ’ s P r e f a c e ix
P r e f a c e xi

Introduction: Diagnosing Madness—Imagining the

Psychiatric Patient, 1850–1920 1
chaPter 1 The Patient as a Psychiatric and Legal Subject in
Nineteenth-Century America: Between Norm and
Normal 9
chaPter 2 Wrongful Confinement in Late Nineteenth-Century
Fiction: Sensation, Fact, Public Fear, and Compound
Rhetorical Situations 35
chaPter 3 From Admissions Records to Case Notes: The
Illocutionary Power of Occult Genres 56
chaPter 4 Narrative Survival: Personal and Institutional
Accounts of Asylum Confinement 79
chaPter 5 Symptoms in Search of a Concept: A Case Study in
Psychiatric Enregisterment 103
Conclusion 131

aPPendix 1 Henrietta Unwin’s Medical Certificates and Case

Note Excerpts from Her 1866 and 1867 Ticehurst
Hospitalizations 139
aPPendix 2 List of Baldwin’s Hospitalizations at Ticehurst 145
n o t e s 147
B i B l i o g r a P h y 163
i n d e x 173
i l l u s t R at i o n s

f i g u r e 1 . 1 . The Friends Asylum for the Insane, ca. 1840 19

f i g u r e 3 . 1 . The chain of “uptakes” following the request (“Order”)
to confine a patient in the asylum 58
f i g u r e 3 . 2 . Order for the Reception of a Private Patient; Medical
Certificates 61
f i g u r e 3 . 3 . Samuel Newington, letter to the Commissioners in
Lunacy re: Henrietta Unwin, May 3, 1861 66
f i g u r e 3 . 4 . The two Medical Certificates signed by Dr. Thomas Allen
for Henrietta Unwin on different dates in April 1861 67
f i g u r e 3 . 5 . The bidirectionality of uptake 75
f i g u r e 4 . 1 . Ticehurst Asylum, Sussex, England 94
f i g u r e 5 . 1 . Speech chain 105
f i g u r e 5 . 2 . Visual excerpted from Paton showing periodic forms of
manic-depressive insanity from an observed case 111
f i g u r e 5 . 3 . Visual showing course of disease in cases of manic-
depressive insanity 112
f i g u r e 5 . 4 . Coded symptom frequency (one-year increments) in John
Horatio Baldwin’s case notes 126
f i g u r e 5 . 5 . Coded symptom frequency (two-year increments) in John
Horatio Baldwin’s case notes 127
seRies eDitoR’s PReface

In the nineteenth century, psychiatric practitioners turned to confinement

in what were called insane asylums as the remedy for severe cases of men-
tal illness. The practice generated a large body of textual documentation,
especially as it was contested, defended, and administered both in the medi-
cal community and in society at large. Cristina Hanganu-Bresch and Carol
Berkenkotter examine some of resulting texts from a rhetorical perspective,
attending to the ways they exercise a rhetoric of medicine, institutional jus-
tifications of the administrative, legal, and institutional practices, as well as
various forms of resistance to the regime of confinement, including popular
fictions of the horrors of wrongful confinement. This is a deeply humane and
reflective book, astute in its critical readings and challenging in its affirma-
tion of the humanity of the psychiatric subject.
Thomas W. Benson
PReface

This book is the result of years of research spent in archives and libraries on
two continents in an attempt to decipher the textual footprints of asylum
patients. Some of the results of this research have already been published in
Carol Berkenkotter’s book Patient Tales: Case Histories and the Uses of Nar-
rative in Psychiatry, as well as in various journals. Here, we focus on tracing
not just the patients’ medical histories but also their life stories before they
became patients and after they were discharged. We find that the diagnosis
event is the watershed moment in their lives, and so we are looking for the
textual—and textural—makeup of this decision. This was our own version of
“starring the text,” in the words of Alan Gross, of placing rhetorical analysis
of the written word at the center of the web of cultural practices that made
asylums possible in the nineteenth century; thus, we observe firsthand the
psychiatric argumentation practices that led to diagnosis and the patients’
efforts to counter those arguments. For a while we inhabited a world of
fading calligraphy inscribed in esoterically paginated dusty tomes, amalgam-
ated genres that also hosted occasional patient letters and artifacts (draw-
ings, paintings, diagrams, objets d’art sometimes engraved in what appeared
to be the patient’s own blood). Whenever possible, case notes, certificates,
and private correspondence were copied, transcribed, and analyzed (in some
instance coded); and while we used various analytical frameworks, for the
most part we let the texts guide us to what we hoped to be intelligible,
plausible approximations of the embodied experience of mental illness for
those who found themselves in an asylum. We cover both “wrongful” and
“rightful” confinement here, although as we shall see, both “wrongful and
“rightful” are terms laden with judgments and assumptions we may find hard
to adhere to today. We look at the English-speaking world (specifically, the
United States and Britain) because of their shared philosophy of psychiatric
confinement and the commonality of language, and to a period covering
roughly the middle of the nineteenth to the beginning of the twentieth cen-
tury, which is also when asylums came under attack from various sectors
of the general public. Regrettably, our access to American medical archives
has been severely limited because of a restrictive interpretation of laws
xii Preface

protecting patient confidentiality; centuries-old asylum archives, containing

case notes and worlds that have been only tentatively explored so far, lie
beyond our reach. Thus, instead of asylum records, we turned to two other
sources: serialized novels and court proceedings, both of which described
(and pronounced judgments on) cases of wrongful confinement. The texts
we have analyzed here via a variety of heterogeneous methods under the
umbrella of rhetoric capture both the larger nuances of historical phenomena
and the life details of private citizens caught in the psychiatric system.
We wish to thank the extraordinary librarians at the Wellcome Library
for the History of Medicine in London, and in particular to Richard Aspin,
the director of Rare Collections, who helped us wade through many square
meters of handwritten text. We are also grateful to the Haverford College
Quaker and Special Collections staff, in particular Anne Upton, who directed
us to the Hinchman archive, which included press clippings and family
letters. We would also like to acknowledge the reviewers who helped make
parts of this work stronger, in particular the anonymous reviewers for the
journals Literature and Medicine and Written Communication, as well as the
participants in the Rhetoric Society of America’s 2015 Institute on Theory
Building in the Rhetoric of Health and Medicine (especially Jeff Bennett,
whose comments on an earlier version of chapter 1 were extremely useful).
Last but far from least, we are immensely indebted to Kira Dreher, who,
while a research assistant for Carol at the University of Minnesota, helped
transcribe and make sense of the Baldwin case notes and contributed a part
of that chapter.
It is now time to depart from the plural “we.” I left the hardest part for
last: this book was a difficult project to finish because of the premature ill-
ness and death of my coauthor, Carol Berkenkotter. Carol was a shining light
in the world of writing studies, a generous, brilliant, beloved scholar who is
fondly remembered by her students and colleagues. She was also my mentor,
and her work ethic, astuteness, intelligence, and charm will forever be with
me. It has been a surreal experience finishing this without her, as she had
long set the stage and tone for this research agenda. Thank you, Carol, for
sharing your intellect, wisdom, brilliance, and kindness with me and many
others who were fortunate enough to work with you.
Cristina Hanganu-Bresch
Introduction

Diagnosing MaDness—iMagining the

P s yc h i at R i c Pat i e n t , 1 8 5 0 – 1 9 2 0

Studies of nineteenth-century psychiatry have generally focused on famous

cases, doctors, or paradigm changes and ideological movements. They have
more rarely focused on ordinary individual patients’ cases as they appeared
in primary documents such as case notes, admission documents, Medical
Certificates, and so on. We believe that the study of such documents can add
to our modern understanding of mental illness as it was perceived in the
English-speaking world (Britain and America) in the late nineteenth century
and how the subsequent treatment of the “insane” came to be. In particular,
we want to understand the struggle to diagnose mental illness, which had
momentous consequences for the life circumstances of the diagnosed. The act
of diagnosing mental illness was a watershed moment, triggering a cascade
of medicolegal actions that radically changed the course of the patients’ lives,
and which involved extrafamilial authorities to an uncomfortable extent for
a large portion of the public. Studying the textual traces of the diagnosis
process can help us understand how patients, caught in the mental health
system (which in the nineteenth century was the insane asylum), struggled
to assert their identity as individuals, provoking in the process debates about
the meanings of normality, personhood, identity, and autonomy, to name a
few critical topics. Such debates often spilled over into the public sphere via
lawsuits, memoirs, newspaper editorials, essays in literary and legal maga-
zines, legislative forums, and so on, forcing ongoing conversations on the
issue of the definition, rights, and proper treatment of the mentally ill person.
When asylums mushroomed in early- to mid-nineteenth-century Amer-
ica as a result of the tireless campaigns of humanitarian champions such as
Dorothea Dix, they held within the promise of revolutionizing treatment for
the insane. As the philosophy went,1 assuming that they followed a judicious
2 Diagnosing Madness

regimen and inpatient routine, patients who were living in such quarters, far
removed from the “madding crowd,” would have the best chance of being
restored to sanity. The asylum thus offered a humane (“moral”) treatment
for the insane that stood in sharp contrast with some of the more outland-
ish treatments of the past, such as chaining inmates, giving them cold baths,
or putting them in various confining contraptions such as Benjamin Rush’s
“tranquilizer chair.” The reality of the confinement, however, dared to dis-
agree with the theory. As populations exploded (especially in cities, due to
economic and industrial developments that were hard to foretell), so did the
number of the mentally ill and the demand for asylum beds; thus, asylums
became, in the words of Robin Ion and Dominick Beer, a “strange mix of
therapy, social control and moral guardianship.”2
While psychiatric science made little progress, asylums became over-
crowded and inefficient, which led to abuse, neglect, and institutional apa-
thy. In most but the most exclusive establishments, asylum doctors became
consumed by management issues and devoted little time to actual patients.
Psychiatry, already isolated in large out-of-town asylums, also became os-
tracized as a discipline from other medical specialties; it became what one
scholar has described as “a backwater specialty.”3 All this, coupled with the
realization that a cure for most mental illness was failing to materialize, made
the realities of confinement far less idyllic than the original visionaries had
prescribed. Thus, it is no wonder that we see, in the second half of the nine-
teenth century (our focus in this book), more and more discontents with the
system.
Confining a person deemed afflicted with a mental disease to the asylum4
was a pharmakon, both drug and poison, for while it purported to treat psy-
chiatric ailments, it came with the high cost of personal liberty. Accordingly,
the lexicon typically used to describe people caught in the legal and prison
system, including terms such as “confinement,” “inmates,” or “cell,” perme-
ated the medical language used to describe mentally ill patients and to justify
their stay in the asylum. As the two worlds—medical and legal—collided
in asylum practice, psychiatry became an object of public scrutiny unlike
any other branch of medicine. Consequently, diagnosing, or identifying the
nature of the mental illness, became one of psychiatrists’ primary concerns,
resulting in multiple negotiations among patients, families, doctors, the gen-
eral public, and often legal professionals.
In this book, we attempt to capture the nature of those negotiations,
which are by nature rhetorical. By “rhetorical” we mean that the work of
psychiatrists and patients (as well as that of families, writers and journal-
ists, and legal authorities) is one of constant textual persuasion, involving
finely crafted arguments, fluid definitions of disease, and careful linguistic
 Introduction 3

choices that could make the difference between an individual’s personal

liberty and asylum confinement. Such arguments concerned not only the
nature of psychiatric disease (which is intrinsically controversial) but were
also constrained by the gender and social status of the patients, the profes-
sional and legal status of the practitioners, and the larger democratizing and
professionalizing forces shaping English and American societies at the end
of the nineteenth century.
We are aware of the difficulties of diagnosing patients retrospectively,5
and that is not our goal here. Rather, we aim to describe some of the ways
social and medical actors made sense of mental illness and negotiated diag-
noses. In that sense, we try to mirror Robert Aronowitz’s goals in Making
Sense of Illness, which took a historical approach to the social constructions
of diseases such as Lyme disease, chronic fatigue syndrome, and coronary
heart disease among others. By examining the controversial nature of these
diagnoses, Aronowitz exposed the agendas that drove clinicians and patients
and also defined the experience of illness for both. Unlike Aronowitz, who
took a broad historical perspective, our inquiry is firmly grounded in spe-
cific texts that were central to the mental patient’s experience during the
period we focus on—the late nineteenth and early twentieth centuries. Thus,
we are looking at asylums as cultural sites that generate textual ecosystems
revolving around the conditions and nature of psychiatric confinement. The
primary texts that we investigate in the chapters that follow, although in the
public domain, have not been examined elsewhere to our knowledge, except
in our own published works, which form the core of chapters 3, 4, and 5. By
analyzing some of these under-researched genres and documents, we hope
to contribute new knowledge to the literature on the rhetoric of medicine,
the social history of psychiatry, and social studies of science. Additionally,
we also look at fiction genres such as sensation novels that claim to be based
(entirely and truthfully!) on real cases of wrongful confinement; at least one
of these novels has been, to our knowledge, under-researched so far in the
literature dealing with nineteenth-century psychiatric history.
The common focus in all chapters is capturing the moment in which a
person becomes a psychiatric patient—which often occurs at the juncture of
the psychiatric diagnosis. We aim to do so through a close examination of
a constellation of genres generated by that diagnosis. While social (institu-
tional, literary, medical, legal) forces demand new and specific genres that
describe, define, and regulate mental illness, the documents thus produced
have the power to alter the same social factors that required them. For ex-
ample, in both the United States and the United Kingdom, social pressure
regarding alleged asylum abuses gave rise to laws that demanded a stricter
control of asylums, partly through more rigorous documentation. The
4 Diagnosing Madness

resulting documents (admissions records, patient case histories) were the

deciding factor in the destinies of both patients and families. Furthermore,
some patients wrote and even published memoirs or sued the asylum as
a result of their confinement, generating a fresh wave of public discussion
surrounding mental illness (in varied genres such as novels, pamphlets,
newspaper columns, or legal debates). Such public discussion led, in turn, to
new laws, regulations, and attitudes regarding the treatment of mentally ill
patients.

Diagnosing Mental Illness and Wrongful Confinement

in the Nineteenth Century
The issue of diagnosis is the moving target in all these documents—though
gradually, with the dawn of the twentieth century—the once-unquestioned
necessity of asylums as the endpoint of mental patient care gets thrown into
question as well. Our analysis homes in on how mental disease is a matter
of public negotiation much more than a matter of scientific and medical
knowledge. Moreover, we wanted to document the concrete consequences
of these public negotiations on actual mentally ill patients whose lives were
profoundly altered in this process. With our last chapter, we also offer a
glimpse into how that public negotiation of sanity gets professionalized—
a matter to be debated amid specialists rather than in courts of public opinion.
As Annemarie Jutel explains, “the process of diagnosis provides the
framework within which medicine operates, punctuates the values which
medicine espouses, and underlines the authoritative role of both medicine
and the doctor.”6 Jutel argues that diagnosis refers to both preexisting cate-
gories and the process of applying them in practice; it is also a process that
reveals what society’s standards for normal are and offers a grid for imposing
culturally accepted order.7 There is power at play in the diagnosis: for the
doctor who makes it (reflecting the authority and consensus of fellow pro-
fessionals), for the patient (who is henceforth medicalized, or psychiatrized
in our case, and may both gain and lose certain rights), for the discipline of
medicine at large, and (in modern times) for medical insurance entities. It is
also a matter of authority for the state, as the recognition of certain diseases
as parts of the accepted nomenclature may trigger consequences—of the
economic, legal, and social variety. For example, admitting the existence of
PTSD or of the AIDS epidemic has had momentous consequences for a sig-
nificant group of afflicted patients from multiple points of view, insofar as
it has offered the relief of recognition to previously unnamed suffering and
has opened avenues for financial, social, and emotional support; but it also
has material consequences for the medical profession and research institutes
 Introduction 5

working on cures and clinical practice guidelines, as well as the state, which
will have to allot governmental resources for research and treatment.
In the case of mental illness, while no one doubted its existence,8 very
few could agree on definitions and boundaries—where to “carve nature at
its joints.” The process of imagining and reimagining taxonomies in psy-
chiatry still goes on to this day, though we can trace its modern incarnation
to Kraepelinian nosology, something we address in our last chapter. Along
the way, we have sought to capture in historical medical texts the incep-
tion of diagnosis as a label—and we have tried to corroborate its genealogy
in contemporary texts (journalistic and fiction genres). The lessons of the
nineteenth-century “moral insanity” debate, for example, show that diagnos-
ing mental illness as a whole becomes ensnared in controversy the moment
it becomes a matter of public discussion. Publicly shared a priori concepts of
mental disease will matter more in this instance than professional consensus,
and they may even help erode that consensus.
A counterpoint theme to that of diagnosis is the trope of wrongful
confinement, which pertains to many of the cases we discuss, and occurs
when patients or families dispute the diagnosis and, therefore, the treat-
ment (that is, interference of the state). At a moment when patriarchal
familial relationships are tested by modernizing forces such as urbanization,
industrialization, capitalism, and population growth, the authority of the
family, especially of the patersfamilias, is further undermined by impersonal
institutions and regulators. This challenge may lead to public confrontation
on the nature of authority affecting a person’s legal competence (these are
themes that we particularly address in the first two chapters). The trope thus
touches on a variety of aspects: the medicolegal aspects of confinement; the
social, political, and legal status of asylums and doctors; Victorian morality;
American principles of freedom and justice; the public fears of institutional
abuses as well of financially motivated villains taking advantage of the
system and working under the guise of familial concern; and, of course,
debates surrounding the definition and diagnosis of insanity. We must also
point out that the trope is sometimes invoked in cases in which the lens
of history shows there was little use for it. Such was the case of Ebenezer
Haskell, whose complaint of wrongful confinement in the Pennsylvania
Hospital won in court in 1868 despite ample expert testimony and extraneous
evidence that there was no evidence of an abuse of power and that he had
been suffering from a form of mental illness.9
The recurrence of wrongful confinement cases slowly eroded the public
trust in psychiatry; public trials, in which diagnoses were fought in court,
revealed severe holes in the doctor’s understanding of their own categories
6 Diagnosing Madness

and furthermore showed these categories being at odds with the common
sense of the common juror. As if the onslaught form the public and legal
professions were not enough, psychiatrists were also fending off attacks
from fellow professionals as well, such as celebrated neurologist Silas Weir
Mitchell, who as late as 1894 delivered a scathing address to the Association
of Medical Superintendents of American Institutions for the Insane. Of the
gulf separating the progress of psychiatric versus other branches of medi-
cine, Mitchell famously said, “With you it has been different. You were the
first of the specialists and you have never come back into line. It is easy to
see how this came about. You soon began to live apart, and you still do so.
Your hospitals are not our hospitals; your ways are not our ways. You live
out of range of critical shot; you are not preceded and followed in your ward
work by clever rivals, or watched by able residents fresh with the learning of
the schools.”10 He deplored the idea that only asylum doctors could care for
the insane, as well as the focus on the business side of asylum management;
in this, he did not just rely on his observations, but he also echoed battles
long fought in court and the newspapers regarding the corrupting influence
of money in asylum confinement.
Since courts deal with grey areas but deliver black and white verdicts, an
antagonistic relationship has taken shape between asylums and psychiatry in
general on the one hand and the general public and the law establishment on
the other. To a degree, we have never escaped this antagonism, even though
we have long abandoned asylums as psychiatric practice; the criticism has
simply moved to other psychiatric instruments, such as the Diagnostic and
Statistical Manual or psychopharmacology. Psychiatric diagnoses and the
medical decisions they engender (such as prolonged hospital stays) can now
be (and are) challenged in court in front of a judge and require legal repre-
sentation and expert testimony.
We look, therefore, at a constellation of genres that have taken pains to
justify confinement—or, conversely, that have tried to attack its premises.
We spend a great deal of time deciphering the traces patients have left in
these texts, knowing, of course, that we cannot exhaust them. We find that
Derrida’s notion of “trace” can be successfully applied here to the notion of
sanity. Derrida’s concept of trace stems from Saussure’s observation that a
linguistic sign is defined in relation—indeed, in opposition to other signs. It
follows, therefore, that any sign contains, a priori, a “trace” of the term(s) it
distinguishes itself from: “The structure of the sign is determined by the trace
or track of that other which is forever absent. This other is of course never
to be found in its full being.”11 In the texts labeling, describing, or contesting
sanity and insanity, we continuously have glimpses at these traces, these
ghostly memories impregnating a diagnostic label with meaning. When we
 Introduction 7

read certificates of insanity, or case notes, or patient testimony or memoirs,

we read about insanity but always in relation to sanity; the conditions that
must be met for asylum confinement imply, always, the conditions under
which a person would not be considered insane. In a sense, in this book we
are trying to weave together these traces.
Our methodology is eclectic and can be broadly subsumed under the
umbrella of rhetoric and adjacent fields such as linguistic and sociolinguis-
tics. First and foremost, we engaged with archives, with text: we labored to
decipher longhand entries in casebooks and correspondence to which we
had access—mostly in the Ticehurst archive hosted by the Wellcome Institute
in London, as well as the Quaker archive hosted by the Haverford College
Library in Haverford, Pennsylvania. The texts and their stories dictated our
approaches: rhetorical, linguistic, and sociolinguistic theory, supplemented
by literary theory when the character of the text required it and was under-
pinned by a historical account. To capture what we set out to do from these
archives requires that we engage in what Trevor Turner called “rhetorical
history.”12 Thus, we subscribe to Turner’s view that “rhetorical history is a
social construction not only in the sense that rhetorical processes constitute
historical processes but also in the sense that historical study constructs real-
ity for the society in which and for which it is produced.”13 Like Zarefsky, we
believe that “the study of historical events from a rhetorical perspective . . .
is the most elusive but possibly also the most rewarding” because it focuses
on “how messages are created and used by people to influence and relate to
one another.”14 We are mindful of Zarefsky’s task for the rhetorical historian
to clarify the “so what”—which in our case is the negotiated nature of mental
illness diagnoses and the value clash between individual freedoms and social
and institutional constraints. In the end, we put our trust, like Erin Frost and
Lisa MelonÇon, in “the capaciousness of rhetoric and the long standing belief
that it is a useful tool in both creating and critiquing discourse.”15 We want
to reemphasize that this kind of rhetorical history work could not be done
without access to a treasure trove of archival materials, such as the ones
hosted by the Wellcome Institute. (Unfortunately, access to American psy-
chiatric case notes and asylum archives over one hundred years old remains,
at the time of this writing, closed in light of what we consider a restrictive
interpretation of patient privacy laws.)
The wider narrative arc that is constructed over the five chapters in this
book is roughly one in which legal and public pressures over the domain of
medicine governed by psychiatrists (or rather, alienists or asylum profes-
sionals) yield modest legislative changes, produce significant shifts in public
opinion, and may in the end be echoed in seismic shifts in psychiatric theory
and practice. In hindsight, these changes may seem inevitable, but they did
8 Diagnosing Madness

not appear so from the trenches. At a particular moment in history, some of

the psychiatric patients who found themselves in one of the most vulnerable
positions of their lives chose to fight or to tell their story; some did not. We
piece together their stories from so-called institutional genre suites (certifi-
cates, admission notes, case notes, and so on), court transcripts, journalistic
accounts, fictionalized accounts of the patients’ lives, and patient memoirs.
Inevitably, patient stories are often secondhand, and we have to rely on wit-
ness testimony, court clerks, doctor accounts, and fiction writers to get an
approximation of their identities, to identify and understand the traces that
end up in their narrative. At the same time, the patients’ negotiated identities
enter into a dynamics with their public(s) and interlocutors: the way they are
presented equally contributes to the professional definition and evolution of
the asylum caretakers, journalists, writers, lawyers, and judges that came
into contact with them. Always, our focus is on records and other written
inscriptions that enter into the asylum ecosystem, enveloping individual
patient histories in textual amber. We conclude our narrative arc with an
account of how Kraepelinian nosology seeped into the diagnosing practices
of asylum doctors, coming at a ripe moment for the psychiatric profession at
large, and making it easier to reduce the “insane” patient to a label as short-
hand for observational practice.
chaPteR 1

The Patient as a Psychiatric and

Legal Subject in Nineteenth-Century
America

Between noRM anD noRMal

On February 4, 1847, Morgan Hinchman, a thirty-year-old wealthy farmer

and member of the Society of Friends (as the Quakers called themselves),
traveled from his home in Bucks County, Pennsylvania, to the Philadelphia
market to sell his produce. Weary of the day’s travails, Hinchman sought to
unwind at the Red Lion tavern, one of his favorite haunts. To his surprise,
he was soon joined by a group of relatives and friends, who, it soon became
clear, were trying to persuade him to check himself into an asylum. They
claimed to act on behalf of Hinchman’s mother, Eliza, and wife, Marga-
retta, who, they said, had been worried about his state of mind for a while.
Prominent in this group were Hinchman’s brothers-in-law Samuel and
Edward Richie, as well as Dr. John Griscom, a long-time acquaintance, whose
(ultimately failed) mission had been to persuade Hinchman to go willingly.
Morgan resisted vehemently but was eventually overpowered, forced into
his own wagon, and transported to Friends Asylum, a well-known Quaker
asylum for the insane.1 Hinchman spent nearly half a year there, after which
he returned to an impoverished estate, a diminished family—one of his
children had died while he was in confinement—and an (even more) es-
tranged wife. Without delay, he sued all those involved for “conspiracy” to
commit him to the asylum and seize his property.2 He excluded his mother
and wife from his complaint, although they had played an important role in
the affair.
The resulting “Hinchman conspiracy trial” of 1849 posed one of the most
notable challenges to the American psychiatric commitment system and
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