The Language of Madness: Understanding Terminology

The timeline for this project is 1870-1940 and the bulk of the research focuses on the 19th century, specifically the Victorian period. The terminology used to describe people with mental illness and mental disabilities is historically accurate, but is rarely used in medical diagnosis or considered socially acceptable in the present time.

In the 19th century, psychiatric medicine was only beginning to be recognized as a legitimate medical field. There was very little scientific understanding of mental illness, so physicians often relied upon accepted social conclusions to explain mental illness. Heredity, environment, gender, class, and 'sinful' behavior were commonly identified as causes of mental illness. Classification of insanity, treatment methods, and asylum design were based on these same principles. Physicians believed that they could cure patients if they could alter the physical environment by removing a patient from the city, or by stopping a then unacceptable behavior such as masturbation, or by surgically removing parts of the body or brain. Conversely, physicians understood that patients suffering from mental illness deemed hereditary could not be cured because their condition was inherited rather than acquired.

Much of the terminology from the 19th century focused on sensationalism and was very label driven. In a time when medical science could not fully explain the workings of the mind, society relied upon external factors to justify the unknown. This led, for example, to the continued use of the term lunatic through the 19th century, which was originally derived from the belief that the influence of the moon could drive people to insanity. Similarly, the term insane branded all patients living in insane asylums, including those with non-psychiatric conditions such as learning disabilities, Downs Syndrome, and old age. The blanket use of this term indicates that medicine had advanced enough to understand that mental illness and disabilities could originate in the brain, but had not yet identified the scientific origins of specific conditions. In the context of the time in which they were used, many of these words were not intended to be derogatory. As it was understood in the 19th century, they were simply the most commonly accepted words to describe mental illness.

As approaches to mental health care evolved through the 20th century, the language changed to reflect a more compassion-based treatment philosophy. While terms such as lunatic and idiot are used within this website, they have been used solely to ensure historical accuracy. The evolution of terminology is further evidenced by the numerous name changes experienced by mental health care institutions. Originally deemed madhouses, they evolved to be lunatic asylums, insane asylums, and mental hospitals, to the presently acceptable mental health care facility.