Framing Madness: Robert Jones’s Moral Medicine and the Postpartum Mind

By Eunice Chon

Note from the author: This close reading exercise was for HISTSCI 1770: Broken Brains: A Patient-Centered History, taught by Professor Anne Harrington. We were asked to analyze a primary source in the history of the mind sciences. I chose Robert Jones’s 1902 article “Puerperal Insanity” because I was interested in how this diagnosis served as a precursor to modern understandings of postpartum depression and postpartum psychosis.

Wallis, Geoffrey. “Sir Robert Armstrong-Jones.” Psychiatric Bulletin 15, no. 7 (1991): 432-433.

Puerperal insanity referred in the 19th century to a mental disturbance occurring after childbirth, what we might now identify and heavily discuss today as postpartum psychosis or severe postpartum depression. But a hundred years ago, it was not merely a medical label for a still poorly understood condition. It served as a cultural lens through which physicians assessed women’s moral, emotional, and spiritual character. Robert Jones’s “Puerperal Insanity,” published in the British Medical Journal in 1902, is more than a clinical case study. Drawing on over 3,500 cases from the Claybury Asylum, Jones constructs a nosological framework for diagnosing a distinct psychological condition that privileges certain maternal functions and pathologizes women’s emotional distress once they cease to fulfill those roles. I find that Jones’s diagnostic logic, framed through statistical rhetoric, moral language, and selective medicalization, reflects not merely empirical observation but a broader cultural aim: to discipline women’s affective lives in accordance with early 20th-century ideals of maternal duty, moral purity, and domestic propriety. His work exemplifies how psychiatric categories were used to enforce normative expectations, revealing the profound influence of gendered cultural narratives and religious biases on what counted as medical legitimacy. While presented as a clinical report, Jones’s article is deeply shaped by his Edwardian norms, which idealized female domesticity and maternal self-sacrifice, anxieties around illegitimacy, which stigmatized unmarried mothers, and a wider drive to consolidate medical authority over the female body and its morality.

Jones was unusually progressive in limiting the diagnosis to the postpartum period alone; many of his contemporaries diagnosed insanity throughout pregnancy, birth, and lactation. In doing so, Jones attempted to help women he considered blameless. But even as he defended them, his understanding of the condition remained deeply moralistic. Once women ceased visibly performing maternal duties, their emotional distress became legible as pathological. By combining Christian morality and medical reasoning, Jones provides a compelling example of how one physician made sense of postpartum madness within a specific cultural moment, one that merged healing with discipline, sympathy with surveillance, and science with sanctity.

Genre and Medical Authority

Jones writes as both an observer and institutionally empowered expert. His broader career offers further insight into his motivations: a devout Congregationalist and accomplished physician, he was deeply invested in the institutional reform of psychiatric care, pioneering psychiatric nurse training and occupational therapy at Claybury Asylum during his tenure there from 1893 to 1916. He also advocated for public health intervention in mental illness, lectured widely, and contributed to discussions on spiritual healing, juvenile delinquency, and community care. Jones served on an Archbishop of Canterbury's special committee on spiritual healing and a Royal Commission on divorce and matrimonial causes, neither of which are strictly medical positions. His positionality in the community goes beyond a clinician; he is a religious authority who is concerned about the moral and psychological health of the population, not just the individual, and the potential “evolution of insanity.” These personal investments are deeply intertwined with how he interprets female behavior—particularly maternal failure, sexual impropriety, and emotional transgression—as pathological. His position within a major public asylum not only grants him statistical reach but also authorizes a diagnostic framework in which what he judges as moral deviance to be recast as a medical disorder.

As Medical Superintendent at the London County Asylum at Claybury, he presents detailed epidemiological data on 259 women whose insanity was attributed to reproductive causes. He categorizes them into three causes: pregnancy, puerperal (within six weeks postpartum), and lactational (post-six weeks). Though he notes this categorization is “more convenient than accurate,” he insists that puerperal cases show “such a marked delirium with wildness and delusions of a hallucinatory character, in which religious and erotic features become so prominent that I recognize an almost distinct nosological entity, a view I am bound to confess which is not supported by high authorities.” Here, Jones attempts to both assert clinical authority and elevate a particular form of maternal breakdown to diagnostic status, even as he concedes that his view is not supported by other authorities.

Tone and Language: Pathologizing the Maternal

Although the article presents itself as scientific, its tone often reveals a subjective undercurrent. Jones describes women exhibiting “gibberish nonsense, erotic, immodest conduct and bad language,” demonstrating “evolutions of shameless indecency, accompanied with noisy delirium and marked religious exaltation.” His vocabulary—shameless, immodest, gibberish—reflects more than clinical concern; it reproduces cultural anxieties about emotional excess and deviance from normative female behavior in a religious, Edwardian society. It encodes social judgments about female sexuality, emotional expression, and loss of control.

These anxieties peak in his discussion of religious and sexual delusions in a “person previously of pure and unblemished character.” Jones writes: “Marked sexual excitement, mingled with religious exaltation, is more often met with in this form of insanity than in any other,” concluding that “love and religion are the two most volcanic emotions to which the human organism is liable." By conflating religious fervor, sexual transgression, and madness, Jones fears the uncontained maternal body, no longer obedient to norms of modesty or duty.

Audience Assumptions and Gender Norms

The presumed reader of Jones’s article is a medical professional: likely male, well-versed in asylum administration, and committed to the medicalization of female behavior. The text presumes that women’s reproductive transitions are periods of extraordinary psychic fragility, where “exalted sympathies,” “maternal instincts,” and “disappointment and shame” all become potential triggers for breakdown. This view is especially sharp when Jones discusses illegitimacy. He claims that “the moral shock of disappointment and shame” in unmarried mothers poses an “additional strain” that may precipitate insanity. Among single women who experienced pregnancy-related psychosis, he notes that some were weak-minded, with weakened emotional inhibition, unable to restrain their passion, and more readily tempted.

Persuasive Strategies: Data and Diagnosis

Jones builds his argument through dense statistical reporting, not merely to provide objective evidence, but to construct a rhetorical framework that lends scientific legitimacy to a culturally contingent interpretation of maternal behavior. The numbers he provides, including percentages, case ratios, and comparative trends, are selectively framed to embed his social judgments within empirical language. For example, he reports that among 259 cases: 21.6% occurred during pregnancy, 46.3% during the puerperal period, and 32.4% during lactation. This empirical gesture intends to lend his work scientific legitimacy for findings not widely recognized by higher authorities of his time.

Moreover, his appeal to heredity reinforces an early 20th-century medical preoccupation with biological determinism. He states that “nearly 50 percent [of cases] had some hereditary predisposition,” and calls heredity “great biological law according to which all beings endowed with life tend to repeat the elements and functions of their organism in their descendants.”These claims foreshadow the eugenic rationales that discourage reproduction among 'unfit' women and give rise to moral hygiene campaigns that blame and alienate only women.

Moments of Contradiction and Tension

Despite his confident tone, Jones occasionally reveals the limits of his categories. He admits that “there is no type associated either with pregnancy or lactation” and that the connection between “nerve-cell reduction and consequent psychic changes requires further elucidation.”He also notes discrepancies between his findings and those of colleagues like Clouston, Batty Tuke, and Menzies, but provides little explanation for these variations. These moments invite us to read the article against the grain as a document that performs certainty while also exposing the arbitrariness of its psychiatric taxonomy.

Crucially, Jones’s diagnostic logic is strikingly selective, revealing a gendered double standard in psychiatric labeling that reflects cultural narratives more than medical consistency. His approach implies that women’s emotional instability is only pathologized once they cease to visibly fulfill maternal duties, which frames psychiatric legitimacy in terms of reproductive usefulness. Women in the reproductive states of pregnancy and lactation, as in periods associated with maternal duty, are rarely diagnosed with puerperal insanity. Instead, the diagnosis is reserved almost exclusively for the immediate postpartum period, when the woman is no longer visibly gestating or actively breastfeeding. This pattern suggests a disturbing interpretive framework: so long as a woman is actively bearing or nourishing a child, she is performing her reproductive role and her emotional fluctuations are treated as understandable, even excusable. But once she exits that role, ceases to be visibly maternal, her psychological state becomes suspect. Reproductive utility appears to shield women from a formal diagnosis of insanity.

Jones writes, “In the insanity of pregnancy and lactation, my experience leads me to conclude that there are no general symptoms characteristic of these periods, and in the pregnancy cases, no unanimity of opinion other than that the third stage of labour in the insane is perhaps generally precipitate can be obtained.” Those patients may have experienced slower contractions, hemorrhage, or stubbornness, but Jones disagrees with other doctors at the time that insanity starts to occur during conception. Jones writes, ‘I have never met with such a case,” and “a transient insanity during delivery has not come under my notice” either.

Troubling implications remain. He implies that a woman’s psychological legitimacy is contingent upon her biological usefulness. When she is no longer performing her childbearing function, her mental instability is no longer interpreted as situational or hormonal but instead becomes pathological. While one could argue that Jones's view is influenced by biological phenomena, such as the drop in oxytocin after birth or when breastfeeding stops too early, which is associated with mood disorders, this explanation does not fully justify his diagnostic selectivity. Women also experience emotional volatility during pregnancy and lactation, yet their symptoms are not pathologized to the same extent. Thus, Jones’s diagnostic structure does not simply follow a biological arc; it also maps onto a cultural narrative about when a woman’s emotional life is deemed tolerable or intolerable: blameless or scrutinizable.

Contextualizing Jones: Historiographical Insights

The diagnostic logic in Jones’s article, especially the exclusion of pregnant and lactating women from formal diagnoses of insanity, echoes a longer history of selectively pathologizing women's reproductive states. As Nancy Theriot argues, nineteenth-century diagnoses of puerperal insanity cannot be separated from their gendered and institutional contexts: they were “a behavior pattern expressing dissatisfaction or even despair over the constraints of womanhood,” which physicians transformed into disease categories that “both legitimized the behavior pattern and played a role in medical specialization.” Jones’s framing of postpartum breakdowns as a unique nosological entity, while exempting pregnancy and lactation, reflects this dynamic even if he diverged from his contemporaries. Rather than universalizing female reproductive instability, he pathologizes only those moments when women cease to fulfill maternal expectations, a pattern Theriot interprets as the product of both gender ideology and professional boundary work.

Hilary Marland similarly underscores the cultural selectivity and instability of puerperal insanity as a diagnosis. In Dangerous Motherhood, she shows how asylum case notes and published medical treatises often wavered between biological and sociological explanations, offering sympathy toward women as individuals while simultaneously reinforcing a framework in which maternal failure, poverty, and loss of domestic control became triggers for institutionalization. Jones’s data-heavy report fits this mold: his tone is at once paternalistic and accusatory, and his focus on unmarried mothers, in particular, reproduces the psychiatric conventions imposing pervasive cultural stereotypes regarding femininity and insanity on women who defied their gender roles. Moreover, Jones’s diagnostic framing can be read through what Marland calls the “ambiguities of puerperal insanity.” In “The Birth of Puerperal Insanity,” Marland explains that midwives like Jane Sharp and Martha Mears framed these states as emotional or nervous disturbances due to bodily sensitivity and social stress, not as pathological insanity. They emphasized care, rest, and maternal support rather than institutionalization or diagnosis. Midwifery treated emotional changes as natural. Only once male medical professionals took over did these become classified as pathological insanity. Jones’s insistence on differentiating puerperal psychosis as distinct reflects a bid to cement psychiatric jurisdiction over the maternal body, claiming ownership of a social crisis rendered medical.

These sources help us see that Jones’s selective pathology identified is not merely an individual bias, but rather symptomatic of larger epistemological and institutional forces. Puerperal insanity operated as a floating signifier—alternatively explained by heredity, exhaustion, grief, or sin—and was invoked when women failed to conform to narrow ideals of maternity. The deeper irony, as Marland and Theriot note, is that asylum physicians often justified this diagnosis leveraging women’s own maternal devotions: expressions of despair, anxiety, or fear for the child became signs of madness when they threatened the smooth reproduction of domestic norms.

In light of this broader cultural history, Jones’s engagement with puerperal insanity must also be situated within his broader intellectual and professional commitments. As a proponent of modernizing asylum care, Jones combined clinical innovation with concern for the social implications of mental illness. His attention to reproductive and moral 'strain' in women parallels his public remarks on syphilis, stress, and degeneration in modern life, which he saw as products of overstimulation and ambition. His motivation, therefore, was not merely diagnostic or therapeutic but also civilizational: to uphold a vision of social order threatened by the destabilizing forces of modernity, including shifts in gender roles, sexual norms, and domestic structures.

Conclusion

Jones’s article is a rich site for examining the intersection of medical science, gender ideology, and social control, illustrating how diagnostic categories reflected not purely medical necessity but dominant cultural beliefs about femininity, motherhood, and moral conduct in early 20th-century Britain. It exemplifies how psychiatric writing was shaped not only by emerging diagnostic methods but also by cultural narratives about gender and reproduction. His language, diagnostic boundaries, and selective categorization of insanity all reveal deeper assumptions about what kinds of women were seen as emotionally tolerable or threatening to social norms. By defining puerperal insanity narrowly, diagnosing it primarily after a woman has fulfilled her reproductive function, Jones reinforces a view of female psychological legitimacy as conditional upon biological utility. This has lasting implications: it reflects a medical discourse that both mirrored and perpetuated social hierarchies, where motherhood offered temporary protection from pathologization, and deviation from maternal scripts invited surveillance. His work may have been driven by reformist intentions and informed by biological theories, but ultimately, “Puerperal Insanity” reveals how psychiatry helped codify a moral economy of womanhood.

References

Jones, Robert. “Puerperal Insanity.” British Medical Journal. March 8, 1902. 579-586.

Marland, Hilary. Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (New York: Palgrave Macmillan, 2004).

Theriot, Nancy. “Diagnosing Unnatural Motherhood: Nineteenth-Century Physicians and ‘Puerperal Insanity.’” American Studies 30, no. 2 (1989): 69-88.

Wallis, Geoffrey. “Sir Robert Armstrong-Jones.” Psychiatric Bulletin 15, no. 7 (1991): 432-433.