Lactational Insanity Syndrome

Lactational Insanity Syndrome was a term once used to describe the mental anguish of women who had given birth. Nearly all medical writers in the late 19th century describe the mental derangements occurring during pregnancy (the puerperium) and the nursing period under the collective title 'puerperal insanity'.
[Newgate prison]
Some authors classified puerperal insanity into the insanity of pregnancy (the puerperal period proper) and the insanity of lactational (the nursing period). They arbitrarily assumed that the latter begins six weeks to two months after labor[1].

Prolonged or excessive lactation is given as the chief cause of insanity occurring during the nursing period. However, it remained ‘an untidy, elusive disorder’, without any shared understanding of a unique symptomology or treatment protocol.

The syndrome was entrenched in Victorian expectations of proper womanly behaviour. New research clearly shows that the class or social status of the patients had a bearing on how their conditions were perceived and rationalized. The diagnosis was further coloured by the values assigned to it and may have been reserved for some women and not for others. Thus there existed a sharp contrast in the way that middle-class and working-class women were diagnosed[2]. A vivid description of the squalid and inhuman conditions in Victorian hospitals and asylums can be read in E.S. Thomson's 'Beloved Poison' and 'Dark Asylum'.

Yet, women can be seriously depressed after childbirth and postpartum psychosis has been described for over 2,000 years. Modern science supports a genetic component to the risk, but the Diagnostic and Statistical Manual of Mental Disorders still does not include it as a diagnosis[3].

[1] Rohé: Lactational Insanity in Journal of the American Medical Association – 1893
[2] Campbell: 'Noisy, restless and incoherent': puerperal insanity at Dundee Lunatic Asylum in History of Psychiatry – 2016
[3] Friedman and Sorrentino: Commentary: postpartum psychosis, infanticide, and insanity--implications for forensic psychiatry in Journal of the American Academy of Psychiatry and Law – 2012

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