Mental health problems among medical practitioners are a touchy subject. There has been research on anxiety, depression, and burnout in different occupations, and medicine has come in for its share of attention, but it is a difficult topic to address in the present given twenty-first century aspirations to seemingly infallible practice. It is reassuring, I hope, to learn that we can also study the phenomenon in the past and realise that infallibility or perfection is a myth in medical practice; current practitioners might take comfort from predecessors who were human first, and qualified doctors second.
My survey of selected English ‘lunatic asylums’ in the Victorian period reveals a multitude doctors who were admitted as patients. These men suffered from the same range of supposed diagnoses and causes of ill-health as their non-medical peers, but with some specifically medical inflections. These occupational details bear witness to the stresses of a career in medicine, and the obsessive thoughts that could arise from medical work. Frederick Wright, for example, was admitted to the Derbyshire county lunatic asylum in 1856 after threatening violence to his fellow practitioners who he thought were conspiring against him to undermine his living. William Tinney, who was admitted to the private Wonford House asylum in Exeter, also in the 1850s, had a different experience because his medical knowledge inspired occupational delusions of grandeur; he thought that he could cure all diseases by breathing on the sick. In this way, both the strains of making ends meet and the knowledge infused by medical training had a strong influence on the way that doctors presented as asylum patients. The asylum case notes of 165 such men are treated in more detail in chapter five of my recent book, Medical misadventure in an age of professionalism, 1780-1890.
But what of the ‘blue devils’? In researching the book I came across two clear but stray references to depression that invoked this phrase to describe low mood, by doctors confronting the rigors of medical training or practice. In the first, Dr Anthony Fothergill, a successful physician in Bath, was writing to James Woodforde, a student at Edinburgh’s medical school in 1792. Woodforde’s side of the correspondence is lost but he presumably wrote to his unofficial mentor about depressed emotions. In doing so he gave Fothergill the chance to describe such feelings in a late-eighteenth century style and in the process offer some excellent advice to students in the present as well as the past. Fothergill wrote to Woodford on 6 October 1792:
I am truly concerned to hear of your indisposition which is evidently of the hypocond[riaca]l kind and plainly brought on by too intense application and the want of due exercise and amusement…you must resolutely observe ye following rules, for these blue devils must absolutely be brushed off or they will take possession of you and render you a moping useless being … remember you are born to nobler ends, and therefore banish spleen – banish melancholy. Allow yourself 2 hours for brisk exercise every day, whether in fencing, dancing or riding a rough-trotting horse, which last is the best because ye exercise is in the open air. Devote 2 or 3 evenings in a week to music or convivial meetings, but exclude all intemperance … By the above method I hope you’ll soon regain your wonted health and vivacity. But you must not think ye time lost that is to be thus devoted to exercise. Remember health is too important to be sacrificed to books and solitude.” [emphases in the original]
Wise words indeed: but critically Woodforde was not alone in suffering something like our modern diagnosis of depression as a practitioner-in-waiting, and Fothergill was not alone in making this vivid characterisation. More than thirty years later, William Dicken, a newly qualified surgeon, set sail for Bengal and a posting in the Indian Medical Service. Dicken was, like a number of recruits to India, miserable at having to leave Britain and his on-board journal of his first journey to the subcontinent is full of nostalgic reflection on life in England and of trepidation for his future. He reached a particularly low point on arrival in Calcutta but before disembarking, when he wrote, “I have never felt so miserable since I left England as I do tonight … Everybody save myself seems happy, all have their friends coming off to welcome and take them on shore … a fit of the blue devils.” His own prediction – “I daresay a good night’s rest will make me myself again” – fortunately proved prescient, as he soon found life in Calcutta to his taste.
The phrase ‘blue devils’ was used and popularised in the late eighteenth and early nineteenth centuries by colourful prints employing the motif of demons to considerable effect. The same sort of creatures are referred to in plays, poems, novels and opera libretti, such that the appearance of blue devils became a proverbial shorthand for a state of low spirits or depression, and was taxonomised by Chesterton in the late nineteenth century as Caeruleus Lugubrious.
It is perhaps little wonder that medical practitioners in the past might sporadically identify these demons as invading their own lives. No doubt practitioners in the present wrestle with their own demons.
Alannah Tomkins is a Professor of Social History at Keele University in Staffordshire, UK.
- C. Lawrence, P. Lucier and C.C. Booth (eds), “Take time by the forelock”: The Letters of Anthony Fothergill to James Woodforde 1789-1813 (London: Wellcome Institute for the History of Medicine, Medical History supplement number 17, 1997), p. 38.
- British Library, European Manuscripts C. 366, Journal of Dr William Stephens Dicken (1804-61).