This article accompanies Philippa Carter’s piece “Childbirth, ‘Madness’, and Bodies in History” in History Workshop Journal issue 91, where it is currently free access.
In March 2021, I had ‘madness’ on the mind. I was finishing a doctoral thesis on early modern ‘frenzy’, an illness which contemporaries described as causing terrifying changes to thought, mood, and behaviour. I had also just seen my article ‘Childbirth, “Madness”, and Bodies in History’ released online, in advance of its publication in HWJ 91. It was at this time that I came across Catherine Cho’s 2020 memoir, Inferno: A Memoir of Motherhood and Madness.
With unflinching honesty, Cho recounted her memories of an episode of postpartum psychosis in 2018:
I went to feed Cato, holding him close, but noticed that my hands were clutching him tightly. Would I suffocate him? His eyes darted, looking at me with fear. And then it happened. His eyes were devils’ eyes: dark eyes with flashing red pupils.
I’m not sure if I slept, but the next moment my eyes were open, and I heard a voice. It was a voice in my head but it spoke with clarity and strength. Each time it spoke, the room filled with light. Somehow, I knew it was the voice of God. “Your son needs to die.”
When I collapsed, pulling at my clothes and screaming, James shouted for help. I felt the demons rush towards me, their faces pressing in gleefully, their hands on me as they twisted my ankle. I fought and screamed, scratched, bit, kicked. I felt the hands pull me down to Hell.
Reading Inferno, I was struck by the resonances between Cho’s words and those of the seventeenth-century English medical practitioner about whom I had written. Between 1597 and 1634, Richard Napier treated at least fifty female clients whom he described as having fallen ‘mad’, ‘frantic’, ‘distracted’ or ‘lunatic’ after giving birth. One new mother was attacking her relatives and calling them ‘devils’. Another reported that ‘the devill entred into her mouth’. Several others had heard the devil instructing them to kill their babies.
Today, diagnoses like ‘madness’ and ‘frenzy’ are neither clinically recognisable nor socially acceptable. They remind us of the wide gulf between the seventeenth century and the twenty-first. So, too, does the fact that Napier’s casebooks are the only records which we have of these events. Cho was given a notebook and pen in the New Jersey psychiatric ward to which she was admitted, and her copious writings from her stay there form the basis of the book. Very few of Napier’s recently delivered clients would have been taught how to write anything more than their names. As far as we know, no first-person account of their experiences remains.
The minds of these individuals were, by the judgement of their doctors and relatives, lost. They are doubly lost to us. Historians are rightly wary of using sources like Napier’s casebooks to diagnose people who died hundreds of years ago. The continual revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disordersreminds us that our own categories of mental disorder are far from stable. Imposing these categories on a past society, Joanne Edge has argued, is bound to obscure more than it reveals.
Sticking a present-day label on Napier’s clients is unhelpful at best. But I can’t rid myself of the impression that their experiences had something in common with those of Cho. Where Cho’s hallucinations had points of reference in Korean folklore, Dante, Greek mythology, and digital surveillance, theirs were dominated by a distinctively early modern English ‘devil’. Yet all of these new mothers described descending into their own personal version of hell.
The causes of postpartum psychosis are still poorly understood: genes, hormone levels, and disturbed sleep patterns are all thought to play a part. Cho is frank about the toll which the three months leading up to her episode of psychosis had taken on her: after sepsis and an emergency C-section came sleep deprivation, mastitis, and familial scrutiny. Napier, too, placed his clients’ ‘madness’ in the context of the physical and psychological hurts which they had sustained during and after their deliveries.
Are the similarities between these narratives coincidences? Are they my projections onto the past? I am not sure. But if we think that the physical complications of childbirth have a history as old as our species, we should probably be willing to consider the possibility that the same goes for its psychological risks. Maybe the answer to this question doesn’t matter much. What does matter is that individuals in crisis are spotted, heard, and helped. We are lucky to have a new generation of authors writing their stories of postpartum mental ill health. I am writing in memory of Napier’s patients, who could not write their own.