A Beautiful Mind – Laura Makepeace Stephen and the Earlswood Asylum medical archives (15 Oct 2015)

Speaker: Dr Madeleine Oakley

This week’s lecture was given by Madeleine Oakley, who co-writes with Katerina Koutsantoni the paper on Laura Makepeace Stephen, a patient that was admitted to the Earlswood Asylum in 1893-7. What made Laura particularly fascinating to researchers was the fact that she was Virginia Woolf’s half-sister, by Leslie Stephen’s first wife, Minnie Thackeray, the daughter of William Makepeace Thackeray. The anomaly of Laura’s mental disabilities in a literary and high-achieving family made her case all the more interesting. In this post I will summarise Laura’s biography, the state of the Earlswood Asylum while she was there, and modern hypotheses regarding her condition. I will close with some reflections on the merits of applying modern science to pre-modern medical cases and the ethical concerns that come with it.

Laura Makepeace Stephen

Laura was the first child born to Leslie Stephen and Minnie Thackeray. At birth, she was slightly premature, which may have contributed to her condition. She was at first praised by her parents and family for her beauty, vivacity, and was expected to “grasp the pen” quickly to follow in the family’s literary footsteps. However, after the sudden death of her mother Minnie, Laura was under the care of her aunt and the family began to notice that Laura was not behaving as other children her age would. She was slow to speak, not stuttering all the time but speaking in a ‘lock-jaw’ manner, straining and boggling over words. Steph records that sometimes she would spit meat out of her mouth and choke on her food at the age of fourteen. Laura was a major frustration and disappointment for her father, especially after his second marriage to Julia Duckworth, whose nondisabled children in contrast to Laura’s condition made Laura appear all the more ‘abnormal’.

Julia and Leslie Stephen decided to send Laura away to a governess in 1886 at the age of sixteen, to get her away from the family and the other children, who were finding their half-sister an uneasy presence. At twenty-three in 1893, Laura was finally sent to Earlswood Asylum, where she would stay for four years, then moved to the private care of professionals until her death in 1945.

Diagnosis

When Laura was admitted into Earlswood, she was initially diagnosed as suffering from ‘imbecility’, a mental disability between ‘idiocy’ and ‘feeble-mindedness’. Psychiatric diagnoses at this time were primitive and there were no established rules of classifying mentall illnesses. But there were specific and definite legal definitions for these terms. The Idiots Act of 1886 meant that institutions such as asylums not only had to care for their patients, they had to train and educate them too so that they do not remain useless members of the community.

Laura had difficulties in learning and expressing herself through language. At the asylum she was reported to be “talking wildly to herself”, was “noisy and incoherent”, and “shouts and gesticulates at night”. Laura’s agitations are clearly not symptoms of simply learning disabilities. In 1901, Laura was described as a ‘lunatic’. As David Wright rightly points out, there is a semantic gap between ‘idiot’ and ‘lunatic’, where one never had a mind to begin with, and the other simply lost his mind. It is strange then that Laura mangages to lose a mind that she never had in the first place. Newman proposes that Laura suggered from a pre-existing congential mental disability and developed an additional psychotic condition when she was in asylum.  Oakley on the other hand suggests that these symptoms could be signs of Laura’s autism, which would explain her unpredictable behaviour of tantrums and lack of communication skills.

Family

Leslie found it increasingly hard to cope with Laura’s condition, especially after the death of Minnie. Laura could not be managed by her aunts at home, and was only worse when Julia entered the family. Julia felt indignant of Laura’s insolent, “perverse” behaviour, and Stephen no doubt felt ashamed of his firstborn. Stephen could no longer focus his attention of Laura, with seven other children to look after, and expresses unpaternal frustrations with her, calling her “backward” and wilful, finding her obstinacy “intensely provoking” and  wanted to “shake the little wrtech”. The imagined violence in Stephen’s language suggests the inadequacy and deficiency of the household in dealing with a special needs child like Laura. Stephen and Julia could not discipline Laura and make her perform tasks as they wish; the loss of parental power over the child not only indicates a breakdown of hierarchy but also a breakdown of familiarity, since Laura clearly was not well appreciated or loved in the new home. Oakley points out the meagre familial contacts that were kept when Laura was institutionalised and the fact that the family did not even know when she died in 1945. Laura did not feel attachments to her family and was arguably more comfortable away from them.

Oakley also suggests possible sexual abuse from her step-brothers Duckworth boys as a cause for her reluctance to be with her family. As Woolf later claims that she and her sister were abused, so it would be possible and likely that Laura too, as a mentally disabled girl unabled to communicate, be an easy victim of sexual abuse. This would account for her apparent ‘nonsense’ at the asylum where she would repeat words like “boys”, “bed”, “family”. Sexual abuse in childhood could have caused a co-morbid psychiatric disorder that would explain her psychotic behaviour on top of her existing autism.

Genetics

When it was first indicated that Laura had a mental disability, Leslie Stephn blamed his wife’s family. Isabella Thackeray, Minnie’s mother, was instutitionalised for psychosis after the death of Minnie. Oakley sugests that the more likely genetic connections are actually on the paternal side. Leslie Stephen’s father was prone to depression; his son, Fitzjames/Leslie’s brother developed senile dementia in his old age; Fitzjames’ son/Leslie’s nephew developed depression and bipolar disorder, and was later admitted into an asylum for mania; Leslie Stephen himself was likely to be cyclothymic, prone to violent mood swings. Woolf herself suffered from depression. The family history of the Stephen family makes it highly likely that whatever conditionLaura may have acquired after birth, her genetic makeup means she was more vulnerable than others.

Conclusions

It would be a lost cause to attempt post-mortem diagnoses on Laura and other past patients with our modern definitions of mental illnesses, particularly when these definitions are themselves continuously changing. Indeed psychiatric labels would not be helpful in understanding the lives of mental health patients in the nineteenth-century. As researchers, we are inclined to want to discover the truth about the past, to ‘give the past a voice’. Archives give us insight into the lives of many otherwise unknown patients. Yet it is perhaps difficult to draw the line between academic interest and obsessive antiquarianism; certainly patients like Laura have had their bodies and lives ‘poked’ enough during their lifetimes – do we really need to do it to them after death? Although the archives become public after 100 years, these are nevertheless still patient records, highly personal, intimate information. Should we read them without the consent of the patients themselves, persons who were unable to communicate consent in the first place? Would we want our medical records scrunitised in a hundred years?

As regards the causes and treatment of Laura’s condition, it is easy for us with our modern scientific knowledge and as champions of social welfare to condemn the alienation of Laura in the family and the possible psychological/emotional/physical/sexual abuses she could have had. But it is not for us to morally judge Leslie Stephen and his decision to instutitionalise Laura; the little evidence we have would suggest that she was no better off at home anyhow. Laura was not a typical case. If Laura had not been the daughter of Leslie Stephen, the granddaughter of Thackeray, and half-sister to Virginia Woolf, would we have even taken interest in her? After all, Laura was only mentioned in passing in reference to Woolf in Hermione Lee’s biography. Perhaps what this research can or will do, is to put mental patients like Laura on centre stage in their own rights, with the dignity and respect they deserve, not as appendages to famous family members but as subjects in themselves.

Koutsantoni, Katerina, and Madeleine Oakley, “Hypothesis of autism and psychosis i nnthe case of Laura Makepeace Stephen”, Disbaility Journal (2014)

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