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Narrative Survival: Personal and Institutional Accounts of Asylum Confinement

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The concepts of narrative and of genre share a family resemblance in the sense that there are many sorts of narrative genres that run across the various spheres of human activity from literature to anthropology, to history, law, medicine, and psychiatry. In particular, in the field of narrative, non-literary memoirs have become the object of considerable scrutiny.1 While not a review of this literature,2 this essay seeks to enhance scholars’ understanding of the “illness narrative” as a genre by going backward in time to a period in 19th century British psychiatry when clinical narratives in asylum casebooks were central to the practice of psychiatry. These casebooks were essential to psychiatry as an emergent professional field because patient histories constituted the raw material basis of observation leading to diagnosis. Because casebooks were consulted by magistrates and lunacy commissioners who visited England’s asylums regularly, the patient case histories were essential to insane asylum record-keeping and accountability. Yet, institutional case histories were not the only narrative genre existing to document illness and its treatment. Indeed, “counter-narratives” began to appear at the beginning of the decline of asylums for psychiatric treatment in the second half of the 19th century. Written by former asylum patients, these texts documented the often cruel practices or neglectful treatment at the hands of insensitive keepers, and they were of considerable interest to the Victorian reading public as “survivors’ narratives,” which, along with journalistic exposés and novels, shaped public opinion as well as English law regarding the treatment of the insane. These “survivors’ tales,” that is, personal experience narratives written by those who had been released from the asylum, were met with resistance from psychiatrists, the representatives of the asylum system, who relied on institutional accounts of the patients’ confinement to justify treatment choices or other professional decisions. It is not surprising, then, that institutional documents, such as certificates of insanity, admission records, and case histories often tell a different story than the one proffered by patients who were seeking justice, redemption, and/or catharsis. In the following essay we focus on two intimately connected cases from the archives of Ticehurst Asylum, England.3 Herman Charles Merivale and Walter Marshall, both patients at Ticehurst in 1876 and 1877, found common ground in the shared belief that neither was mad. Each man, after leaving Ticehurst, produced a narrative—Merivale, a memoir, Marshall, an oral testimony—that challenged the status quo ante of the medico-legal institutional authority that existed at Ticehurst Asylum.4 By “status quo ante,” we mean the practice of basing confinement on “certification” by physicians, surgeons, and apothecaries untrained in psychiatry; the institutional case history of each patient; and the Lunacy Laws5 as a whole. Merivale and Marshall produce interdiscursively linked narratives in which they identify themselves as “survivors” of the experience of asylum incarceration for a period of several months. Merivale’s experiences at Ticehurst are described both in the asylum records and in his memoir, My Experiences in a Lunatic Asylum by a Sane Patient, published first in serial format in the magazine The World in 1878 (a year after his discharge), and as a book in 1879.6 Marshall’s confinement can be pieced together from three sources: institutional records, his oral testimony in front of the Select Commission on Lunacy Laws in 1877, and Merivale’s memoir. (Indeed, Marshall’s story is recounted by Merivale as a cautionary tale and a nutshell version of his own.) At the core of both former patients’ narratives is a brief for sanity, supported by the argument that to place a person suffering from nerves, fatigue, hypochondria, etc., rather than actual “madness,” in an asylum with the truly insane, is to insure that the sufferer will descend into insanity. Seen together, the two narratives corroborate each other and raise the issue of the need for a better system of checks and balances to guarantee protection for individuals who were eccentric, but not necessarily mad. Our primary goal in this essay is to compare both Marshall’s and Merivale’s “asylum survivor” narratives to the information in their medical admissions records and case notes, as entered in the Ticehurst Asylum...
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Narrative Survival: Personal and Institutional Accounts of Asylum
Confinement
Cristina Hanganu-Bresch
Carol Berkenkotter
Literature and Medicine, Volume 30, Number 1, Spring 2012, pp. 12-41
(Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/lm.2012.0006
For additional information about this article
Accessed 1 Jun 2013 23:01 GMT GMT
http://muse.jhu.edu/journals/lm/summary/v030/30.1.hanganu-bresch.html
 
Literature and Medicine 

Narrative Survival: Personal
and Institutional Accounts of
Asylum Confinement
Cristina Hanganu-Bresch and Carol Berkenkotter

          
            
          
         
          
          
          
            
       
         
        
        
       
       
         
         
         
           
           
          
         
          
        
          

          
          
        
           
        
         
         
           
    
         
 
          

        
       status quo
ante         
           
       
         
          
interdiscursively       
          
        
         My Experiences in a
LunaticAsylum by a Sane Patient      
  The World         
          
          
         
         
             
     
         
           
           
           
           
       
          
        
          
 
      
          
        
           
 invites         
          
           
        
         
   
           
       
        
          
     
          
          
        
          
          
        
         
           
         
           
         
           
          
 
          
         
          
       
           
 Candide   Gulliver’s Travels    
        
         
            
            
      
        

          
        
          
          
         
           
   
         
        
          
            
        
          
          
          
          
         
     
     
       
           
          
          
           
          
           
         
        
          
        
           
         
   
           
  
        
           
         
 
        
           
          
           
       
        
          
         
           
          
       
       
             
            
            
 
        
          
            
             
          
    
         
        
        
          
          
           
            
            
         
       
          
      
          
        
         
          
         
        
         

         
          
          
           
        
       
    
    
       
         
          
        
          
         
           
          
            
         
          
        
          
        
       
         
        
        
          
            
        
 
          
         
          
    
        
          
        
         
 
       
         
          
    
          
            
           
         
       
        
          
           
         
           
        
         
         
   
         
         
    
        
         
          
        
            
            
        
         
   
        
         
         
       
          
       
          
            
      

    
         
            
        
           
       
        
           
            
        
         
       
        
         
 

          
          
           
           
         
                
          
           
  story          
              
  

        
   
        
        
         
           
          
           
         
         
         
        
 
            
       
         
        
    
           
         
         
         
           
          
          
           
          
            
          
         
         
         
          
  
       
  
       
          
  
          
          
             
          
         
          
           
        
           
        
         
          

       
         
       
         
      
        
         
          
      
         
             
     
   
   
             
   
          
           
            
  
           
            
          
           
     
          
           
           
           
          
         
     


          
        
   
 
        
             
         
        
         
          
         
        
       
         

          
  
           
        Still hears voices
  
          
          
   admits hearing the voices, which annoys
him exceedingly.
             
         
     Still confesses to hearing voices.
             
  saying he could hear my (HN) voice and that I was
playing billiards with his father
   Hears voices      
        
         
        
         
            
            
          
         
        
           
         
          

              
      
       
         
           
         
         
          
         
        
    
  
 
           
          
         
       
          
           
           
           
         
            
           
           
        
          
         
             
           
      
         
           
            
       
          
        
 
         
          
         
          
 folie circulaire  olie a la double forme   
     folie circulaire   
           
           
         
          
          
          
            
         
          
          
          
       
         
          
          
           
           
          
            
         
         
   background
 foreground 
       
         
         
          
     
       
  
   
          

          
            
        
          
         
         
         
          
          
         
            
            
          
            
         
           He’s
a Lunatic         
      My Experiences in a lunatic
asylum by a Sane Patient       
         
         
          
             
             
      
  
         
        
            
           
         
         
            
        
            
    
          
        
       
         
            
 
          
         
           
         
   Hard Cash   
    
         
         
           
    lettre de cachet     
        
          
         
           
         
             
           
       
        
  
            
       pathos   
          
          
     
           
            
         
           
           
           
            
             
           
           
  
      
            
            

            
         
         
           
        
          
           
          
           
          
         
       

     
          
         
 
         
      
        
          
             
        

         

          
           
            
          
          
          
          
            
        
          
          
            
         
 
           
        
            
          
       liberavi anima mia, 
          
          
           
             
           
    Bar, Stage, and Platform: Autobio-
graphic Memories        
         
          
          
           
            
        
   
 
            
         
       
          
          
          
           
            
           
  

 
            
          
          
              
          
        
          
           
         

           
        
          
           
         
         
  
      

   My Experiences in a Lunatic Asylum by a Sane
Patient         
          
         
         
        
            
         
      
           
          
              
         
 Hamlet
          
       
         
         
farrago               
           
         
            
             
       
          
          
   
    
      mise-en-abyme 
 
         
             
          
         
  
           

           
         
      
Anatomy of Melancholy. 
        
          
         
 
           
           
        
           
         
          
        
       
        
 
        
       
         
          
         
          
         
          Minutes
of Evidence Taken Before theSelectCommittee on Lunacy Law
            
             
              

            
            
            
          
            
          
               
              
   
           
           
               
            
          
             
           
            
             
           
            
           
    
        
           
         
          
          
         
        
    
             
           
            
              
              
             
           
            
 
        
           
            
           
     
         
           
          
         
     
              
            
            
              
              
             
             
            
  
    
            
           
          
   
        
           
            
           
        
            
         
              
      
            
     
          
         

           
           
        
         
            
         
       
           
             
          
            
             
           
       The Trial 
           
          
          
         
         
        
       
          
   
          
              
    
       
       
           
        
              
         
          
     
        
           
           
       
            
 
          
            
          
     
        
          
          
         
             
              
         
          
         
           
         
         
         
                  
            
         
     
        Book of Common Prayer
       Book of Common Prayer  
           
             
              
            
    
           
          
         
          
          
           
         
     
       
          
          

        
         
         
         
          
           
          
          
       
          
            
          

 
       
          
         
         
         
         
          
           
      
   
          
          
       
  
          
         
        
   Anatomy of Criticism     
          
        
          
         
          
           
 
          
           
            
  
      
         
            
          
         
         
         
          
        
          
         
       
         
         
           
          
        
            
         
      
         
        
          
         
           
          
         
         
        
           
        
           
         
  


 Narrative Medicine Stories Matter
 Constructing Panic  The Illness Narratives   
    Healing Dramas and Clinical Plots 
   Psychoanalysis and Narrative Medicine
   Patient Tales 
          
         
         
          
            
           
              
             
           
         
            
            
           
             
          
            
           
          
             
    Psychiatry for the Rich   A Diagnostic
Analysis
            
          
             
            
           
           
        
          
   dramatis personae        
            
     
  
 
  How to Do Things with Words
      
        
  Narrative Medicine
    
           
              
              
           
      
    My Experiences, 
  
 
           
          
   
           
           
             
  Psychiatry for the Rich
   




  History of Mental Symptoms
         
             
   Psychiatrie    Clinical Psychiatry
   
     
   
   
  The Content of the Form
 Aspects of the Novel 
 Narrative Medicine 
 Narrative Causalities 
   
          
             
           
   fabula   syuzhet     
           
            
              
                 
  
 Explaining People 
    
          
          
   
          
            American
Journal of Psychiatry,            
           
              
            
           
            
             
             
        
           
            
  The History of Mental Symptoms 
      

          
        
   

      
  Psychiatrie: Ein Lehrbuch für Studirende und Aertze  
  
   

 The Woman in White
 Hard Cash
 My Experiences in a Lunatic Asylum     
        Sun and Shadow 
 My Experiences 

              
            
           
           
     The Atlantic       
             
   
 My Experiences 
 
    
 My Experiences 
    
 My Experiences 
 
 
 The Anatomy 

          
            
              
       
 My Experiences 
         
  avant la lettre         
             
            
    
 
            
           
          
      
Minutes of Evidence Taken Before the Select Committee on Lunacy Law 
 

 
 The Trial 
Minutes of Evidence 
   
 
   

 My Experiences 
         
           
       
 
 
 

Manuscript sources.        
          
          
  
   How to Do Things with Words    
 
       The Routledge Handbook of Discourse
Analysis          
  
 Patient Tales: Case Histories and the Uses of Narrative inPsychiatry
       
        
         Written Communication
     
   The History of Mental Symptoms. Descriptive Pyschopathology Since
the Nineteenth Century.      
       Discourse &
Communication      
       A Manual of Psychological Medicine
Containing the History, Nosology, Description, Statistics, Diagnosis, Pathology, and
Treatment of Insanity with an Appendix of Cases.    
     Constructing Panic: the Discourse of Agoraphobia 
     
  Narrative Medicine: Honoring the Stories of Illness   
  
       Literature and Medicine  
      Stories Matter: The Role of NarrativeinMedi-
cal Ethics    
  The Woman in White    
       Medical Times and Gazette 
              
              
   
     He’s a Lunatic. A Farce in One Act.  
  
        Atlantic Monthly Magazine 
 
       Bulletin de l’Académie deMédi-
cine   

 The Rhetoric and Ideology ofGenre: Strategies for Stability
and Change        
     
   Aspects of the Novel      
  The Anatomy of Criticism.     

      American Journal of Psychiatry    
   
  Narrative Causalities      

  The Trial         
 
  The Illness Narratives: Suffering, Healing, and the Human Condition
    
  Clinical Psychiatry: A Textbook forStudents and Physicians  
     
 Psychiatrie: Ein Lehrbuch für Studirende und Aertze     

  Psychiatry for the Rich: A History of Ticehurst Private Asylum,
17921917   
      
     The Anatomy of Madness: Essays in the
History of Psychiatry          
     
  Healing Dramas and Clinical Plots: the Narrative Structure of Experi-
ence      
      Social Science and Medicine 
 
   Bar, Stage & Platform: Autobiographic Memories   
   
 My Experiences in a Lunatic Asylum by a Sane Patient   
 
  Hard Cash: A Matter of Fact Romance     
   
           
    British Parliamentary Papers, 1877
   . Critical Inquiry       
 
           Sto-
ryWorlds: A Journal of Narrative Studies   
        Science    
  
       Psychoanalysis and Narrative Medicine
        
  A Diagnostic Analysis of the Casebooks of Ticehurst House Asylum,
Psychological Medicine,  
   
       Speech Acts in Argumentative Discus-
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  The Content of the Form: Narrative Discourse and Historical Representa-
tion      
... 93-100; 424-425). 5 See(Berkenkotter & Hanganu-Bresch, 2011) for the Unwin and Marshall cases,(Hanganu-Bresch & Berkenkotter, 2012) for the Marshall andMerivale cases, (Hanganu-Bresch, 2014) for the Hinchman trial, and (Hanganu-Bresch, 2019) for the concept of moral insanity. 6 See(Schreber, 1903) and its (in)famous analysis in(Freud, 1911). ...
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In a rather long piece which an exhibition catalog has called „catholic propaganda”(Busch & Maisak, 2013, p. 342), Guido Görres reflected on madness and art, using Kaulbach’s iconic 1835 drawing of asylum inmates (Das Narrenhaus) as pretext. Görres wrote of “this hospital of the human spirit (…), this charnel ground of the living, who like specters roam, wearing on their foreheads the faded and almost illegible traces of their former names.”1(1836, p. 9). Overdramatic prose, but unlikely to strike one as unprecedented. If anything, it has long been customary to exhibit a mix of fascination and revulsion when discussing the institutions which in the past two centuries at the same time sheltered and shattered those deemed mentally ill.
... The purpose of the enquiry was to examine how the diagnosis was established and to investigate how treatment and care affected the woman's condition and the outcome of her admission. The analysis demonstrated that although the information contained in the case history was sparse, a rich picture of each woman's admission developed when the entire case history was read (Kleinman & Kleinman 1991, Hurwitz 2006, Hanganu-Bresch & Berkenkotter 2012. Remarkably, the demographic information was very similar across both periods. ...
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Aim: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885 to 1895) and inter-war period (1925 to 1935). Background: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. Design: An historical study examining healthcare records. The data collection occurred in 2012. Methods: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman’s diagnosis was congruent with the outcome of her admission. Results/Findings: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. Conclusion: Historical investigations of healthcare records provide legitimacy for current healthcare practices.
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The work of Carol Berkenkotter and others who have expanded the realm of personal narrative studies over the past several decades would not have been possible without the pioneering efforts of those who first brought the study of narrative to nonliterary discourses. By revisiting what personal narratives were to these pioneers—working outward from William Labov in particular—this article considers how the early expansion of the field helps us to understand the far wider expansion of multimodal personal narrative today. In doing so, I suggest that understanding the notion of a personal narrative requires a twofold commitment to inquiry: first, about what makes it narrative; and second, about what makes it personal. These commitments hinge on two crucial junctures, what I call the problem of scope and the problem of autonomy. Framed as questions, the former asks, When does a narrative begin and end? The latter asks, Whose narrative is it? This recuperative essay shows that the heuristics of scope and autonomy can be useful ways to think about the ongoing complexities of personal narrative and its analysis.