The historiography of puerperal psychosis: a Cinderella sub-specialty

The diagnosis ‘puerperal psychosis’ or ‘puerperal insanity’, as it was termed in the 19th century (Loudon, 1988), refers to a severe mental illness that manifests shortly after childbirth. The puerperium, also known as the postpartum or postnatal period, begins immediately after the birth of the baby and lasts for 6 weeks (Hollingworth, 2016). Puerperal psychosis occurs in this 6-week period, with peak onset usually within 2 weeks of birth; it has a good short- to medium-term prognosis, as most women respond well to treatment and make a complete recovery (Thamban and Naquib, 2016). This condition should be considered part of the psychiatric discipline; however, the consequences of ‘getting it wrong’ can have devastating repercussions for the woman, her child and her family (National Institute for Health and Care Excellence, 2001).

George Mora (1965) described modern psychiatry starting at the end of the 18th and beginning of the 19th centuries. This coincided with the publication of Pinel's (1806) ‘treatise on mental diseases’, emphasising Pinel's importance as the initiator of modern psychiatry. Mora (1965) explained that the end of the 18th century was a time of change from ‘unconscious forms of psychological healing in cultures and eras unaware of the importance of psychological problems to the introduction of forms of psychiatric treatment based on the recognition of psychological factors (moral treatment)’.