Maternal Madness and the Making of “Mothers” and “Reproducers” in Nineteenth Century U.S. Medicine

In the nineteenth century, the specter of maternal madness haunted a very particular kind of woman: white, upper- or middle-class, and "civilized." For U.S. physicians, puerperal insanity, a mental disorder precipitated by pregnancy, childbirth, or lactation, was understood not only as a pathology of progress but also as a signifier of racial and cultural superiority. This talk explores what the paradoxical and racialized logic surrounding puerperal insanity reveals about the relationship between motherhood, mental illness, and the construction of racial hierarchy and difference in the nineteenth-century United States. Drawing on transatlantic exchanges of knowledge between the slaveholding United States and Europe (and its colonies) and detailed patient case histories, it shows how the burgeoning racial sciences, obstetrics, and psychiatry cast puerperal insanity as a disorder to which "civilized" white women were particularly vulnerable while simultaneously elevating them as "proper" and redeemable mothers deserving of medical care and sympathy. Conversely, the non-white "uncivilized" other was deemed invulnerable, making their psychological suffering invisible or implausible and reducing such women to mere "reproducers": women who gave birth and raised children yet were denied, both discursively and materially, full maternal subjectivity. In recovering puerperal insanity as a racialized category, this talk makes a broader intervention: that the maternal mind, not just the maternal body, was a critical terrain on which racial difference was inscribed and naturalized in nineteenth-century U.S. medicine. 

Udodiri R. Okwandu is an Assistant Professor in the Department of Women’s, Gender, and Sexuality Studies at Rutgers University-New Brunswick. As a medical historian, she examines how race and gender have shaped medical knowledge and practice in the United States since the nineteenth century, with a focus on the enduring reproductive and psychiatric health inequities affecting Black communities, especially Black women. She received her PhD and MA in the History of Science from Harvard University. Her scholarship has been generously supported by organizations like the American Council of Learned Societies, American Association for University Women, Consortium for History of Science, Technology and Medicine, and the Institute for Citizens & Scholars. Some of her writing has been featured in Social History of Medicine and The Nursing Clio Reader: Histories of Sex, Reproduction, and Justice (Rutgers University Press, 2025) and is forthcoming in History of Psychiatry. She is also currently in the process of becoming a certified doula, a non-medical birth worker that provides continuous physical, emotional and informational support to childbearing people, through DONA International. This work reflects her commitment to promoting reproductive justice both within and outside academia and has played a critical role in deepening my understanding of contemporary birthing experiences.