Alexander Morison and the Symptomatology of Mental Disease

Lindsey Stewart is a 2nd year PhD student at the Open University with CHASE. Her thesis examines the intersection between Victorian fictional representations of heightened emotion and the nineteenth-century symptomatology of mental illness. Lindsey is speaking at the Bethlem Museum of the Mind on the 5th September at 2pm about Victorian Physician Alexander Morison’s commissioned sketches of Bethlem patients. You can find her on Twitter @mind_lindsey


Richard Dadd, an accomplished painter and patient of the Bethlem, famously depicted his physician, Alexander Morison (1779-1866), using his own wry version of physiognomy. Care-worn but kindly, signalling a weary farewell with his hat, Morison’s reputation is casually dissected by two watching fish-wives. Attached to the Bethlem Hospital from 1835, Morison by all accounts, emerges as an adept networker but not an intellectual heavyweight. Having begun his career in 1810 as the Inspecting Physician of Lunatic Asylums in Surrey, he made five visits to Jean-Étienne Esquirol (deviser of the modish psychopathology monomanie) at the Paris Salpêtrière, bringing many of his ideas back across the Channel. Following his appointment at the Bethlem, he became the personal physician to Princess Charlotte and, later, to her husband, Leopold, King of Belgium. When Queen Victoria succeeded to the throne he was knighted.

Morison’s first book Outlines of Lectures on Mental Diseases (1825) is part of the early wave of alienism which promised cure through medical and moral treatment. Described unsparingly by Andrew Scull as ‘an unoriginal melange of ideas’,[1] its significance rests on its status as the first and only course of practical lectures on mind science at the time. In Morison’s defence, he is refreshingly honest, throughout this and his other works (Cases of Mental Disease with Practical Observations on the Medical Treatment (1828) and The Physiognomy of Mental Diseases (1840)) about the self-consciously limited Victorian grasp of mental disease. For example, he asserts that phrenologist Dr Franz Gall’s mind science is an ‘imperfect knowledge’.[2] Where Gall had sought exhaustively to extend ideas of definitive localisation of function in the brain, Morison insisted that, as far as mental disease was concerned, post-mortem examinations revealed indistinct inflammation, ‘very seldom confined to one convolution’.[3] The brain might be a supposed cause of illness but this was of little workable use to the Asylum Superintendent.

Morison was prepared to pick and choose aspects of others’ work where he felt these were practicable, rather than adopting a position wholesale. He commissioned artists, principally Alexander Johnston and Charles Gow, to draw patients at a number of asylums, including the Bethlem. These drawings illustrate The Physiognomy of Mental Diseases. He also records accompanying patient histories using the psychopathology of the day: mania, monomania (in all its inclusive and variant forms), dementia, idiocy and imbecility. As one would expect these images focus predominantly on the face, but also record details of costume. Occasionally patients are shown in restraining garments: ‘strait-jackets’ or leather mitts and Morison acknowledges their use with a brief justification in each case. The book is particularly interesting for its self-promotional ‘before and after’ sketches: moral management is implicitly defended throughout.

The underlying ‘scientific’ premise of physiognomy for its originator J.C Lavater was a corresponding analogy between facial features and the ruling passions of the mind, and this is ostensibly Morison’s rationale in his own book.[4] But details of measurements and size of facial features are, in fact, conspicuously absent. Instead, attention is repeatedly drawn to demeanour, behaviour and affects: blushing, crying, pupil dilation, looks of ‘contempt’, attempts to kiss and also, perhaps most importantly, the patient’s own narrative of their distress. In fact Morison is especially keen to establish the patient’s pre-history, arguing in the text’s preface:

In order to conduct the mental treatment with efficacy, one most important object is to obtain full information of the patient’s previous history, and particularly of the mental cause giving rise to, or at least intimately connected with, the production of the disorder. Such may be excessive application to business or to study, political anxieties, commercial difficulties, religious doubts, disappointed affections, remorse of conscience, and various passions. Possessed of such knowledge, and familiar with the physiognomy of mental disease, we are the better able to appreciate the phenomena of his delirium, the association of his ideas in general, and the tendency of those ideas on which his mind chiefly dwells, thereby foreseeing and preventing mental irritation, removing or diminishing uneasy sensations, and lessening the frequency of fits of fury or of despondency.[5]

This emphasis upon an introspective approach to the causes of madness owes much to his friend and sometime mentor Alexander Crichton whose work An Inquiry into the Nature and Origin of Mental Derangement (1798) maintained that the actions of the mad had motives and were potentially intelligible. Alongside Morison’s religious convictions and his newly imported Esquirolian ideas on symptomatology and categories of mental disease, it was this idea of patient pre-histories which informed his use of moral treatment. The viewer of these sketches is, in a sense, free to make their own inferences from these images, guided only by the intermittent but insistent juxtaposition of illness and cure. Indeed, the depiction of the same face twice belies the fact that madness is fixed. Sometimes, Morison reminds us, the patient’s madness is brief and episodic. Here we are shown a patient with mania and his subsequently cured state:



Nonetheless many of the sketches in Morison’s Physiognomy, indeed the majority, do not have a paired ‘after’ sketch as a ‘cure’ had not been forthcoming. This accumulation of chronic patients who eluded cure in asylums came to influence the wider culture’s view of madness as largely inherited and physiological.

Where previously in the seventeenth and eighteenth centuries pictures of the mad had used a paucity of allusions: the madman’s straw crown, his semi-naked condition, the drool or foam at his mouth and the staring or fascinated eyes, a crude and early symptomatology emerged. Lack of inhibition and self-neglect were the key signifiers of the more emphatic or ‘raving’ form of madness. Similarly in literature madness lent itself to many metaphoric senses but, in the main, it was part of a rhetoric of derogation and humiliation. Physiognomy, for all its many and various faults, played a part in humanising these previously animalistic images and contributed to a more sophisticated symptomatology.


[1] Andrew Scull, Charlotte MacKenzie, Nicholas Hervey, Masters of Bedlam: The Transformation of the Mad-Doctoring Trade, Princeton University Press, 1996, 136.

[2] Alexander Morison, The Physiognomy of Mental Diseases, London: Longman, 1840, 2.

[3] Morison, 2.

[4] See John Casper Lavater, Essays on Physiognomy, trans. T. Holcroft (1789), 9th edn. London: William Tegg, 1855.

[5] Morison, 18- 9.


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