Hypothesis of autism and psychosis in the case of

Laura Makepeace Stephen

by Katerina Koutsantoni* and Madeleine Oakley*
INTRODUCTION
On 7th December 1870, Laura Makepeace Stephen was born at 30 weeks gestation, the first live birth to
parents Leslie Stephen, 38, and his first wife Minnie Thackeray, 30. She was their second child, following the
birth of a stillborn son in 1868. Laura was expected with great anticipation and delight in the hope she would
help eliminate the pain and anxiety her parents had endured for the past two years following the death of
their first child. Lesley Stephen was already well established as a writer and a journalist and Minnie was the
daughter of William Thackeray, one of the giants of Victorian literature. Their joint legacy was a rich literary
one and expectations were significant.
Leslie Stephen expressed wonder at the baby Laura in his letters in which he referred to her as a
gift. Laura, nicknamed Meme, grew up in a stable happy home, surrounded by her parents love and, in
particular, her fathers paternal pride in his daughters beauty and remarkable intelligence.1
In Lauras fifth year, her mother, Minnie Thackeray, suddenly died. Following her death, an
atmosphere of pain and devastation settled in the Stephens home, and Leslies grief was intense. It was at
this time that Minnies sister, Annie, became involved in Lauras upbringing and her nieces lack of intellectual
development became more noticeable. This would have been layered with Lauras grieving for the loss of
her mother, and her fathers feelings of desolation. When Laura entered adolescence, her behaviour became
increasingly more difficult. This resulted in Leslie placing her in the Earlswood Asylum for Idiots in 1893; she
was 23 years of age. She was discharged in January 1897 and remained in the care of professionals until
the end of her life in 1945.
The existing literature about Laura Makepeace Stephen makes it difficult to establish facts about her
condition and treatment. Upon Lauras admission to Earlswood, her Form of Mental Disorder by the Registry
of Admissions states that Laura Makepeace Stephen is an Idiot, in common with the majority of the patients

* Katerina Koutsantoni has a background in English literature, applied linguistics and English language teaching methodology, and
obtained her PhD at the University of Birmingham, UK. She has published a monograph as well as articles in peer reviewed
journals on Virginia Woolfs essays. She currently works as a manager of postgraduate taught Programmes at the Institute of
Psychiatry, Kings College London.
* Madeleine Oakley is a practising Systemic Family and Psychoanalytic psychotherapist and a senior tutor at the Institute of
Psychiatry, Kings College London, where she leads the MSc Mental Health Studies.
1

L. Stephen. Selected letters of Leslie Stephen. Vol One. ed J. Bicknell. London: Macmillan, 1996, pp. 101-02.

Electronic copy available at: http://ssrn.com/abstract=2418709

at this asylum for those with - what is called today - a learning or intellectual disability.2 Further diagnoses of
Laura to date have ranged from imbecility and lunacy3, sexual abuse4, Aspergers syndrome5 and
schizophrenia6. The aim of this paper is to examine Lauras symptomatology and to review her diagnosis
based on more than just conjecture but on primary evidence located in medical archives, as well as
psychiatric research.

SYMPTOMATOLOGY AND OFFICIAL DIAGNOSIS

Laura Stephen was born prematurely in 1870 and in the first five years of her life she was the source of great
happiness for her parents. Leslie was full of paternal pride, reporting that the baby resembled both parents
and was exceedingly pretty. Her head was to him indicative of remarkable intelligence; her hands were
obviously framed to grasp the pen; her feet showed that she would be a first rate mountaineer.7 She was slow
to speak and to teethe, but these did not constitute a cause for concern for Leslie or her mother, Minnie.
It was only after Minnies sudden death in 1875 - when Laura was five - that Leslie began to become
rather anxious. Even so, during the early aftermath of the familys bereavement, Laura remained a source of
comfort for her father. By 1877, Laura, then aged 7, was described by her aunt and Leslies sister, Caroline
Emilia Stephen, as being full of life and she doesnt stop chattering for 5 minutes. Yet, it was in May of that
year that Leslie admitted that Lauras development might not be normal; it soon became apparent that Laura
was indeed not developing normally.8 Years later, Leslie Stephen confessed in his Mausoleum Book that
neither Minnie, nor he nor Anne, his sister-in-law, had perceived that Laura was anything but normal, though
she was obviously a backward child.9
Annie Thackeray and Caroline Emelia Stephen, Leslies sister, both tried to manage the care of Laura
during that time, but Leslie Stephen found Annie too soft with Laura, and Caroline Emelia, or Milly, unable
to manage her, despite her efforts to be strict. In August 1877, Anne Thackeray married Richmond Ritchie
and became less involved in her nieces life. Meanwhile, a new figure was emerging in the lives of Leslie and
Laura Stephen: the recently widowed Julia Prinsep Duckworth. In 1877 Leslie appointed Julia to be Lauras
guardian, and a year later, in 1878, he married her. Laura was eight when they married, and was thus moved

Form of Medical Certificate. Admissions Registry, Earlswood Asylum: The Asylum for Idiots, Earlswood, Red Hill, Surrey.

Available at Surrey History Centre, ref. SCH 392/21/ 41.

3

H. Newman. Laura Stephen: A Memoir. London: Cecil Wool, 2006, various pages.

L. De Salvo. Virginia Woolf: The Impact of Childhood Sexual Abuse on her Life and Work . London: The Womens Press, 1991, p.

36.
5

J. A. Kottler. Divine Madness. San Francisco: Jossey-Bass, 2006, p. 107.

J. O. Love. Virginia Woolf: Sources of Madness and Art. Berkeley: California Press, 1977, p. 164.

Stephen. Selected letters of Leslie Stephen, pp. 101-02.

Newman, pp. 11-12.

L. Stephen. Sir Leslie Stephen's Mausoleum Book. ed. A. Bell. Oxford: Clarendon Press, 1977, p. 44.

Electronic copy available at: http://ssrn.com/abstract=2418709

in with a new mother and a family of children around her own age: George, Stella and Gerald, aged 9, 8 and
7 respectively.
Laura struggled to learn to read, could not write, and seemed unable to concentrate. Just four apparently dictated - letters from Laura to her aunt Anne survive in the Eton College archives.10 On the whole,
the content of the letters relates to things that would interest any little girl, such as school and her friends
there. The only indication of abnormality is the fact that Laura was unable to write the letters herself, though
she signed them with a crude signature. The short length of the letters also suggested limitations.11
Jean O. Love cites extracts from Leslie Stephens letters to Julia Jackson Stephen, which describe
her symptoms. At age seven, Laura developed a number of strange mannerisms involving her mouth and
throat, including straining and boggling over words12 and a lockjaw way of talking.13 Sometimes she made
what Leslie called a spasmodic uttering, queer squeaking or semi-stammering and he said he couldnt
understand why she didnt stammer altogether.14 She would also sometimes spit meat out of her mouth at
mealtimes.15 At age fourteen Laura complained of choking through meals.16 In her own writings, Virginia
Woolf made reference to Thackerays grand-daughter and her own half-sister as
... a vacant-eyed girl whose idiocy was becoming daily more obvious, who would hardly read, who
would throw the scissors into the fire, who was tongue-tied and stammered and yet had to appear at
table with the rest of us.17
Following Leslie and Julias marriage in 1878, Laura was placed within a household of typically functioning
children who complained loudly about her disabilities. This must have reinforced to Leslie how abnormal his
own daughters development was, increasing both his and his new wifes anxiety and distress.18 From this
time, Leslie treated Laura as backward and wilful, and was upset and enraged by her wicked behaviour,
her recalcitrance at her lessons, and what he often called her perversity. He lost his temper with her, knowing
that this was counterproductive, but found her obstinacy intensely provoking: I long to shake the little
wretch.19 Julia too made a moral reading of Lauras abnormalities and tried to discipline her. Yet both

10

The letters came to the Eton College Library collection in 1993, and were collated by Linda Fowler. They were purchased along

with Annie Richie Thackerays diaries in the same year. Confidentially, the library archivist, Mr Michael Meredith (formerly English
Master at Eton for 3 decades), has visibly rubbed out the word dictated, following a subjective decision on his part.
11

Newman, pp. 13-14.

12

Leslie Stephens letters to Julia Jackson Stephen (LS/JJS) 1883; in Love, p. 162.

13

Ibid.

14

Ibid.

15

Ibid.

16

Ibid.

17

V. Woolf. Old Bloomsbury, in Moments of being. ed. J. Schulkind. Florida: Harcourt, 1985, p. 142.

18

Newman, p. 14.

19

H. Lee. Virginia Woolf. London: Vintage, 1997, p. 101.

parents were in reality at a loss about what to do. By 1884, Leslie did not want to put her in a special school
- I cannot think that it would be good for her to be with idiots but gradually he gave up on Laura and she
was sent away.20
In November 1886, at the age of 16, Laura was placed in the care of a Miss Searle, a governess
related to one of the parlour maids at 22 Hyde Park Gate, the Stephens family residence. In the 1891 census
Laura Stephen is recorded as a boarder in the Searle household in Paignton, Devon, at which she spent
several months of the year, although she would still spend some holiday periods with the Stephen family in
St Ives, Cornwall.21 There are no records of Lauras life with the Searle family, and in the Registry of
Admissions at Earlswood where she was later admitted, her History of the Case states that Laura was at
home until 6 years ago during which period she had stayed at a very small private school.22
When she was 23, Leslie Stephen finally decided to send his daughter to the Earlswood Asylum.
Upon her admission to Earlswood in 1893 Laura Stephen was diagnosed as suffering from imbecility.
Imbecility was a milder form of idiocy and a more severe form of feeble-mindedness. More specifically:
Idiot [IQ 0-20] > Profound Learning Disability today
Imbecile [IQ 21-50] > Severe Learning Disability today
Moron [IQ 51-70] > Moderate Learning Disability today
These terms had very definite and specific legal meanings in Victorian England, as is evident in the
Idiots Act which passed through Parliament in 1866. The Idiots Act of 1886 was passed in order to enable
the provision of care, education and training of idiots and imbeciles. While previously all training institutions
for idiots and imbeciles were regarded as licensed houses or registered hospital for lunatics, the Act ensured
that such training institutions were really schools, in which the patients were educated and trained for the
duties of life, and so prevented from becoming useless members of the community.23
Earlswood was indeed seen as a place of rehabilitation. It was intended that idiot and imbecile
children and adolescents were to be sent there to undergo training which would enable them to return to their
original communities and live their lives there, having learnt basic domestic and social skills. It was believed
that if bodily symptoms were controlled and regulated, mental processes would also improve.24 Laura
Stephens medical consultant at Earlswood was Dr John Langdon Down, after whom the condition of Downs
syndrome became named. Down had been the medical superintendent at the Earlswood Asylum for fifteen

20

Ibid.

21

L. Stephen. Sir Leslie Stephen's Mausoleum Book, p. 92.

22

Form of Medical Certificate, ref. SCH 392/21/ 41, 1893.

23

Idiots Act, 1866. British Journal of Psychiatry. 1887; 33: 103-04.

24

Newman, p. 14.

years between 1853 and 1868; he was an eminent Victorian and a leading authority in his speciality: mental
disabilities in children and adolescents.
Laura Stephens admission details and notes, now kept in the Surrey History Centre at Woking, are
a rich source for information about the symptoms of her condition.25 Much emphasis is given - both on her
admission to and discharge from the asylum - to Laura Stephens head measurements. Lauras head
circumference on admission was twenty-two and a half inches, and twenty-three and a half inches on her
discharge in 1897.26 While mysterious to modern eyes, this may have been done to see whether there were
any signs of hydrocephalus or water on the brain.27
During 1893 and 1894, copious notes about Laura Stephens condition were produced. Entries from
October 16th 1983 to February 8th 1894 are preoccupied with the poor state of Lauras teeth. Lauras teeth,
mouth and roof of the palate were in an extremely poor state from October to December 1893, and are a
focus of the clinical notes in the Earlswood Casebook. Newman writes that psychiatrists or alienists of the
Victorian period believed that there was a connection between mental illness and the condition of a persons
mouth. In fact, Newman hypothesises that the deplorable state of Lauras teeth may have had a toxic effect
on her whole body and caused what appeared to be her psychotic symptoms.28
The reality is that people with an intellectual disability may lack skills in self-care, therefore poor teeth
would have been common in this population. Dentistry was and is an expensive business and teeth were up
until the mid-20th century routinely removed from patients with multiple dental problems and few resources to
pay for dentistry. On October 16th 1893, Lauras casebook notes state that she was not very well, her mouth
tender, teeth very bad. By October 26th 1893 the notes report that she has a pussboil ulcerated cheek and
lip ... very rotten teeth and offensive tartar irritable ... Breath very offensive. Saliva collects in mouth. On
November 10th 1893 the notes state that Laura had several bad stumps removed but all require removal.
Her mouth was also treated with nitrate of silver for its generally poor condition according to the entry on this
day. By February 8th 1894, Laura is
[g]oing on very well, is being taught dancing; she has many dislikes and likes. Is usually upset and
cries when visited. Much happier here than at home; mouth getting much better. 29
The focus in subsequent entries in the Casebook shifts, however. By April 5th 1894 the Casebook entry states
that Laura for some time has been sleepless and v restless talking volubly has several delusions but

25

Newman, p. 23.

26

Earlswood Casebook, Earlswood Asylum: The Asylum for Idiots, Earlswood, Red Hill, Surrey. Available at Surrey History

Centre, ref. SCH392/11/4/4, 14th Jan 1897.

27

Newman, p 25.

28

Ibid., p. 26.

29

Earlswood Casebook, ref. SCH392/11/4/4, 16th Oct 1893/ 26th Oct 1893/ 10th Nov 1893/ 8th Feb 1894.

seems much better now again.30 It would seem this could have been the beginning of a psychotic episode
for Laura Stephen. Certainly the notes for all of 1894 record the symptoms of a psychotic illness: Says she
is not Laura Stephen, and has various delusions. Is difficult in matter of food.31 On May 22nd the notes in the
Casebook state that Laura is still hearing voices and talking wildly to herself. Mostly about boys and her
family and is restless and wakeful at night.32 The entry for 28th June 1894 reports that Laura is [I]n much
the same condition, still extremely excitable and incoherent almost, talks volubly to herself and gesticulates
freely.33 On July 29th 1894 Laura is
much the same; was fairly quiet when seen by step mother but usually is silly talkative ... when
upset. Rambles on about boys + being in bed + her family and lots of other disconnected matters.34
These are the same subjects which emerged when Laura was talking wildly to herself and was restless and
wakeful at night two months earlier. On 8th September 1894 the notes report that Laura was not much better
is still very noisy and incoherent.35 In October the problems with Lauras mouth resume and she is reported
to be taking food badly.36 On 12th November, she is a little better, but still bad saliva temperature still
raised at night. She certainly has delusions of sight and hearing. At times shouts out and gesticulates .37
From 1895 onwards, notes on Lauras condition start to become scanty. In January 1895 Laura is
mentally the same though her mouth and teeth in much better condition.38 Almost a year later, on 30th
December 1895, the case notes, written by W. E. Jones, indicate that Laura is now well in health and has
been putting on flesh of late, slight mental improvement. Is not so noisy as she was, but occasionally is very
troublesome.39 Similarly, the notes of April 21st 1896 report that Laura is going on much the same as usual
and occasionally gives a lot of trouble. Well in health, suggesting some stability in Lauras mental state.40
The last surviving clinical entry was recorded on 26th September 1896 stating that Laura was very noisy all
last week, otherwise she has been behaving very well. Lost weight during the Summer but is now putting it
on again. General health good.41

30

Earlswood Casebook, ref. SCH392/11/4/4, 5th April 1894.

31

Ibid., 24th April 1894.

32

Ibid., 22nd May 1894.

33

Ibid., 28th June 1894.

34

Ibid., 29th July 1894.

35

Ibid., 8th Sep 1894.

36

Ibid., Oct 1894.

37

Ibid., 12th Nov 1894.

38

Ibid., 22nd Jan 1895.

39

Ibid., 30th Dec 1895.

40

Ibid., 21st April 1896.

41

Ibid., 26th Sep 1896.

Following a period of four years, Laura was discharged from Earlswood on January 14th 1897 at her
fathers request, although there is nothing in her discharge notes suggesting a recovery in her condition.
Leslie Stephen provides an account of Lauras removal in his entry on April 1st 1897 appearing in his

Mausoleum Book:
My poor Laura was settled with Dr Corner at Brook House, Southgate, on 14th January. We had heard
some complaints of Redhill, where he had been physician, and upon his setting up this establishment
thought it best to place her there.42
This would suggest that Laura was moved, not because she was better, but because the family had become
unhappy with her living at the Earlswood Asylum. Newman suggests that her removal was possibly due to
concerns over a critical government report, dated 30th October 1895, on Holloway Sanatorium at which
incidents of shortcomings, patient neglect and suicides had been exposed. Amongst staff at that sanatorium,
the new head of Earlswood, Charles Caldecott, had been chosen, causing worry for Leslie Stephen.43 In
contrast, Harry Corner who was initially working at the Bethlehem Royal Hospital, a long established lunatic
asylum, had moved to Earlswood Asylum where Laura was a resident in the summer of 1894. He eventually
moved with his family to Brook House in Southgate in 1897 taking Laura with him as a boarder, along with a
nurse to provide day to day care.44
In the 1901 census Laura Stephen is recorded as a boarder in Brook House Lodge. She was the only
boarder there, perhaps because of the comparative severity of her condition. The average age of the nineteen
patients was nearly nineteen: so, at thirty years of age, Laura was well above this. She was, in fact, the oldest
boarder.45 There was also only one patient described as a lunatic out of the nineteen boarders, and that was
Laura Stephen. At Earlswood Asylum Laura Stephen had been classified as an idiot and an imbecile, so
her 1901 classification as a lunatic marks a change. It suggests that the psychotic state which apparently
had begun to develop in her twenties at the Earlswood Asylum for which that institution was not really
equipped to cope - had not improved. However, the Earlswood notes suggest that the psychotic state was
occasional, not permanent. Lauras new description as a lunatic did not mark a dramatic change in her
mental health; Newman argues that this merely meant that her diagnosis had caught up with her condition.46
It may also mean that her condition had changed or that her diagnosis had evolved over time. Diagnosis,
after all, remains a subjective process.47
42

L. Stephen. Sir Leslie Stephen's Mausoleum Book, p. 103.

43

Newman, p. 23.

44

Ibid., p. 31.

45

Ibid., p. 32.

46

Ibid., p. 33.

47

A. Jablensky. The nature of psychiatric classification: issues beyond ICD-10 and DSM-IV. Australian and New Zealand Journal of

Psychiatry. 1999 April; 33 (2): 139.

GENETIC CONNECTIONS
Identifying genetic links in Lauras family could be one way of examining her condition. Lauras mother, Harriet
Thackeray - always known as Minnie - was William and Isabella Thackerays youngest daughter.
Thackerays pretty golden-haired daughter was the third to be born to Isabella, after Annie and a second child
who died in infancy. Hermione Lee argues that the death of the second child in the family had triggered the
psychosis from which Isabella Thackeray would not ever recover.48
Minnie herself had given birth to a stillborn child five years before giving birth to Laura in 1870. Five
years later, Minnie fell pregnant again but there was worry about her pregnancy due to her history. Indeed,
on November 27th 1875, Minnie started experiencing discomfort which turned to convulsions, leading to her
losing consciousness. At the age of thirty-seven, Minnie suddenly died of puerperal eclampsia on Leslies
forty-third birthday.49
After the death of Minnie in 1875, Isabella had a fever which developed into a psychotic state. Like
her granddaughter Laura Stephen later, Mrs Thackeray had to live away from her family for most of her adult
life. She was kept in private nursing homes for fifty-four years.50 And like her granddaughter, Mrs Thackeray
was long lived, living on until 1894 when she died in Leigh-on-Sea in Essex at the age of 78.51
Following his wifes death, Leslie was left alone with Laura, which proved a terribly puzzling and
problematic charge for a broken-hearted widower incapable of looking after himself, let alone a child whose
behaviour, over the next six or seven years, appeared more and more peculiar and uncontrollable. Growing
increasingly frustrated and anxious about his daughters behaviour, Leslie Stephen frantically sought to
explain the reasons behind it by nurturing beliefs that Isabella Thackerays madness had skipped a
generation, thus dwelling on his daughters maternal inheritance. He mentioned fears that Minnie might not
be without some hereditary taint and in this he was not alone. Lillian Shankman writes that Anny Thackeray
also feared there was too much of Isabella (and perhaps a threat of madness) in Minnie.52 Leslie Stephens
retrospective language about his wife points to characteristics of childishness, simplicity, purity, which could
imply developmental delay.
As Isabella Thackerays psychiatric disorder is thought to have been caused by an accidental illness
after Minnies birth, it seems unlikely that it was a genetically transferred disorder. In fact, a letter written by
the elderly Isabella Thackeray in 1889 survives at Eton College, which the College archivist says is anything

48

H. Lee. Virginia Woolf. London: Vintage, 1997, p. 74.

49

Newman, p. 10.

50

Lee, p. 74.

51

Newman, p. 12.

52

L. F. Shankman. Anne Thackeray Ritchie journals and letters. ed. A. Burnham Bloom and J. Maynard. Columbia Ohio State

University Press, 1994, p. 146-48.

but mad.53 Yet Leslie Stephen refused to rule this possibility out, as the opposite, namely pointing the finger
at him and his own family, might lead to more plausible hypotheses for Lauras condition.
Evidence for the possible inheritance of mental ill health certainly appears abundant on the Stephen
side of the family. Sir James Stephen, Leslie Stephens own father, was a gloomy individual, full of sensitivity
and a tendency to sink into depression and hopeless dejection. His son and Leslie Stephens brother,
Fitzjames, was a penalising judge who in old age experienced a decaying mental health and developed senile
dementia.54
Fitzjamess own son, James Kenneth Stephen otherwise known as Jem - started himself to
gradually lose his reason in his late twenties, following a hit on the head by one of the saiIs of a windmill that
worked a pump. Soon after, he began to display symptoms of bipolar disorder, including depression and fits
of wild excitement which also entailed violent scenes of sexual fixation with Stella Duckworth, Lauras halfsister. Jem was sent to an asylum in Northampton where he starved himself to death at the age of 32. The
cause of death on his death certificate was recorded as mania.55 Thomas C. Caramagno examines the
Stephen inheritance and concludes:
Across three generations, then, we find five depressives, two non-specific psychotics, two manicdepressives, and one cyclothymic: an impressive display of familial pattern.56
Sir James Stephens demanding parenthood is thought to have impacted on his sons troubled childhood.
This developed through adulthood and manifested itself in unpredictable mood swings that characterised
Lauras father, Sir Leslie Stephen. Although never very severe, these mood swings were most likely
cyclothymic. Virginia Woolf wrote about her fathers temperamental, unpredictable behaviour in A Sketch of
the Past, citing accounts of his temper related by her aunt, and Leslies sister-in-law, Anne Thackeray:
But I can add something to my fathers steel engraving a violent temper. Even as a child aunt Anny
told me, he would work himself into such violent rages that I forget how she finished the sentence,
but I think it had something to do with smashing a flower pot in a greenhouse; and nobody - nobody
- could control him, she said. This temper that he could not control, and that, considering his worship

53

An extract from Isabella Thackerays letter to Annie Ritchie in the Eton Collection, written in Leigh on 20th March 1889, is cited

below:

My dearest Anny,
I was glad to receive your card yesterday morning and glad to think that you should feel comfortable and resigned to your
change of abode.
The letters overall tone appears totally fluent and does not show evidence of a learning disability. Personal communication with the
archivist, Michael Meredith, has highlighted the same.
54

Lee, p. 61.

55

Newman, p. 43.

56

T. C. Caramagno. The Flight of the Mind: Virginias Woolfs Art and Manic-depressive Illness. London: University of California

Press, 1992, p. 111.

of reason, his hatred of gush, of exaggeration, of all superlatives, seems inconsistent. It was due, I
suppose, to the fact that he was spoilt as a child; because of his nervous delicacy; and that delicacy
excused his extreme irritability.57
Cyclothymia is classified as a heterogeneous condition, distinguished from major mood disorders like bipolar
disorder by its chronicity (i.e. duration of at least 2 years) and subsyndromal quality (i.e. symptoms are less
severe, fewer in number, or of insufficient duration).58 Even though Leslie Stephens cyclothymic episodes
did not carry duration and severity which would qualify them as a major disorder like manic-depressive
psychosis, they were still unpredictable and very frightening for his children.59 As such, Laura must have
stood witness of her fathers violent rage as did Leslies other daughter, Virginia, whose attitudes towards the
mentally disabled and mentally ill were to be coloured forever.
If we accept that there may be genetic roots in Laura Stephens condition, the above appears to point
to Leslie and his family history rather than Minnies. A letter that Baron and colleagues published in Nature
journal in 1987 investigates the X-linkage (the female sex chromosome) hypothesis of bipolar illness; this
received considerable attention from the psychiatric and genetics community. According to the researchers,
because at least one of the primary genes seems to be transmitted by the X chromosome, the illness is
passed from father to daughter or from mother to sons and daughters but rarely from father to son. The
authors observe an excess of females with the condition and a corresponding striking absence of male-tomale transmission, both connected to X-linked dominant inheritance.60 In this case, neither of Leslie
Stephens sons, Adrian and Thoby, exhibited symptoms of a bipolar condition. However, two of his three
daughters seem to have inherited and developed a mental health disorder.
In concurrence with Baron et al, findings by Winokur et al have demonstrated that patients with bipolar
disorder have familial affective illness, with a history of mania running in their families61. Howland and Thase
in turn have illustrated a trend for an increased prevalence of bipolar disorder in the families of subjects with
cyclothymia.62 Leslie Stephens cyclothymic episodes and irritability - not overlooking the history of mental
illness among members of his own family - are likely to have contributed to Laura Makepeace Stephens
psychotic behaviour and institutionalisation. Admittedly, Lauras condition may equally have been inherited
from her mother, and in turn grandmother, yet the fact that both Laura, from Leslies Stephens first marriage,
developed psychosis and Virginia Woolf, his daughter from his second marriage, suffered from and died of
manic-depressive illness, leads one to assume that the genetic predisposition lay with their father. In Lauras
case in particular, the aetiology of intellectual disability and autism we suggest is thought to be the interplay
between genetic history, the psychological and the social context.
57

V. Woolf. A Sketch of the Past, in Moments of Being. ed. J. Schulkind. Florida: Harcourt, 1985, pp. 109-10.

58

R. H. Howland and M. E. Thase. A comprehensive review of cyclothymic disorder. Journal of Nervous Mental Disorders 1993;

181: 485.
59

Kottler. p. 107.

60

M. Baron, N. Risch, R. Hamburger et al. Genetic linkage between X-chromosome markers and bipolar affective illness.

Nature. 1987; 326 (6110): 289.

61

G. Winokur, W. Coryell, J. Endicott. Further distinctions between manic-depressive illness (bipolar disorder) and primary

depressive disorder (unipolar depression). American Journal of Psychiatry. 1993; 150:1176.

62

Howland and Thase. pp. 487-9.

OUR HYPOTHESIS
We aim in this paper to examine signs of a neurodevelopmental disability Laura displayed since she was
born in order to propose a hypothesis of autism. If we acknowledge the symptoms of autism to include,
among others:

a. Language problems affecting either verbal communication (echolalia, incomprehensible language,

low vocabulary for the childs age) or non-verbal communication
b. Socialisation problems, including cases of avoiding eye contact, problems developing interpersonal
relationships, no desire to display or share interests, and poor expression of emotions
c. Behaviour problems: harm to self or others, uneasiness, or lack of obedience
d. Learning problems such as difficulties with talking, reading and writing63

we will examine such aspects as Lauras head circumference, the condition of her dental hygiene, her
social interactions and general behaviour, as well as her manifestations of anxiety and distress caused by
suspicions of sexual abuse.

a. Head circumference
One of two photographs that survive of Laura shows her as a baby. There is no eye contact with the camera;
instead her eyes look troubled and seem to look inwards. This could be symptomatic of the impairment in
social interaction autistic individuals have. According to Qian and Lipkin, autistic babies find the relationship
between gaze direction and intention hard. They tend to attend more to visuo-audial synchronies (such as
clapping hands) than to socially relevant stimuli (such as eyes, faces, and biological motion). The face is for
them a complex, dynamic stimulus that may overload their inefficient learning system, so if a baby cannot
learn the information in the gaze, then he/she will be less interested in looking at eyes.64

63

A. Bravo Oro, J. Vzquez Briseo, C. A. Cuello Garca et al. Early manifestations of autism spectrum disorders: experience of

393 cases in a paediatric neurology. Neurologia. 2012 Sep; 27(7): 416.

64

N. Qian and R. M. Lipkin. A learning-style theory for understanding autistic behaviors. Frontiers in Human Neuroscience. 2011; 5:

77: pp. 5-6.

Figure 1. Reproduction of plate 35f from Leslie Stephens Photograph Album, Mortimer Rare Book Room, Smith
College

A second surviving picture of Laura - taken when she was at Earlswood Asylum - shows her to have a possibly
larger than average head (see fig 2). While there is no data on her head circumference upon her birth, Lauras
head circumference on admission to Earlswood was twenty-two and a half inches, and twenty-three and a
half inches on her discharge65, very slightly larger than the normal range.

Figure 2. Laura Stephen at Earlswood Asylum. Copyright of Surrey History Service.

Newman suggests that measurements were taken at that point because of suspicions of hydrocephalus.
Indeed, excess of cerebrospinal fluid (CSF) in the subarachnoid space, particularly along the convexities of
the frontal lobe in other words, presence of extra-axial fluid was and is an indication of benign external
hydrocephalus. The presenting symptoms of hydrocephalus usually consist in rapid head growth in the first

65

Earlswood Casebook, ref. SCH392/11/4/4, 14th Jan 1897.

year of life, with the greatest head circumference manifesting itself at around 6 months. Hydrocephalus,
however, has been considered benign because it is not associated with a clinical syndrome or a gross
anatomical abnormality, but also because extra-axial fluid typically resolves later in infancy.66 During Lauras
lifetime, very little was known about extra-axial fluid in the brain of infants who went on to develop autism
spectrum disorders (ASD).
Studies starting in 1943 with Leo Kanner suggested that large heads or macrocephaly is a common
physical finding amongst people with ASD.67 Extensive research in later years has indeed demonstrated
some link between macrocephaly and autism. For example, in 2004 Courchesne found that macrocephaly is
not present at birth in children later diagnosed with autism, but results from an increased growth rate in early
childhood. His study showed autistic individuals brain to be at the 25th percentile at birth, which then
increased rapidly to the 84th percentile by 614 months of age. This period of abnormally accelerated head
circumference increase was shown to largely conclude by the end of the 2nd year of life.68 In 2005, Martha
Herbert and her group also identified an increased percentage of macrocephaly, but decided that
macrocephaly does not seem sufficient for autism, especially as it is also found in pervasive developmental
disorder, attention deficit hyperactivity disorder and developmental language disorder.69 Research also by
Fidler et al70 in 2000 and by Froehlich et al in 201371 demonstrated an association between macrocephaly
and impairment in autism, but both teams concurred that it is a finding non-specific to autism. As such, one
could argue that even though Laura Stephens macrocephaly was present and may have been associated to
her behaviour, being just an endophenotype in ASDs it did not necessarily cause her autism.
Most recent research in 2013 by Shen et al, however, has presented findings based on MRI analyses
in the brains of a small sample of infants at risk of ASD. Tests conducted at 6-9 months, 12-15 months and
18-24 months of age demonstrated that infants who developed autism presented with elevated levels of
extra-axial fluid, and as such greater head size, which did not resolve at any of these points.72 Even though
Shen et als sample was relatively small and while we cannot know whether it was the case with Laura that
any extra-axial fluid resolved by age 2, it is a very strong hypothesis, hitherto unappreciated, for a possible
diagnosis of autism.

66

M. D. Shen, C. W. Nordahl, G. S. Young et al. Early brain enlargement and elevated extra-axial fluid in infants who develop

autism spectrum disorder. Brain. 2013 Sep; 136 (Pt 9): 2830.
67

L. Kanner. Autistic disturbances of affective contact. Nervous Child. 1943; 2(21): 248.

68

E. Courchesne E. Brain development in autism: early overgrowth followed by premature arrest of growth. Mental Retardation and

Developmental Disabilities Research Reviews. 2004. 10 (2): 107.

69

M. R. Herbert. Large brains in autism: the challenge of pervasive abnormality. Neuroscientist. 2005. 11(5): 418.

70

D. J. Fidler, J. N. Bailey and S. L. Smalley. Macrocephaly in autism and other pervasive developmental disorders. Developmental

Medicine and Child Neurology. 2000; 42: 739.

71

W. Froehlich, S. Cleveland, A. Torres et al. Head circumferences in twins with and without autism spectrum disorders. Journal

Autism and Developmental Disorders. 2013 Sep; 43(9): 2031.

72

Shen et al, p. 2831.

b. Dental condition
Lauras teeth, mouth and roof of the palate - a focus of the clinical notes in the Earlswood Casebook - were
in an extremely poor state. Poor dental hygiene is in fact relatively common in those with a learning disability.
A study conducted on autistic children in the city of Chennai, India, reported poor oral hygiene, higher rates
of periodontal diseases and dental caries in this population.73 A combination of factors can be responsible for
poor dental hygiene and this may indeed have been the case with Laura. Rekha et al suggest that school is
the best place for examination of autistic childrens teeth. A change of location for dental examination could
provoke negative behaviour and considering Lauras placement in different environments - whether families
or asylums - during her lifetime, her behaviour is not surprising. Many children with autism have difficulty
tolerating exposure to external sounds, lights, odours and colours, which can pose challenges to them in
achieving good oral health.74
In conjunction with this, some children with autism show a preference for soft or sweet foods, have
poorer masticatory abilities, pouching of food, requiring help with tooth brushing, and medications causing
xerostomia.75 Entries cited earlier from Leslie Stephens letters confirm that Laura exhibited symptoms of
difficulty with chewing, spitting meat out, choking when eating. Stephen wrote that during her childhood
Laura would sometimes spit meat out of her mouth at mealtimes, while at age fourteen she complained of
choking through meals.76 Upon her hospitalisation in Earlswood in her twenties, problems with Lauras mouth
resumed, her mouth was still painful and she was reported to be taking food badly.77 These would agree
with the poor masticatory abilities Shapira et al refer to and provide evidence to the argument of her autism
interfering with her ability to maintain healthy oral hygiene.

c. Behaviour
When examining Lauras behavioural symptoms, one wonders whether she did in fact misbehave as her
family thought or whether this was a symptom of her disability. Upon the death of Lauras mother in 1875,
her father, Leslie, and his sister-in-law, Anne Thackeray, were clearly devastated, making any disagreements
that pre-existed between them become even more pronounced. Such disagreements led to major rows and
storming rage, scenes which Laura probably witnessed as a child, then aged 5.78

73

V. C. Rekha, P. Arangannal and H. Shahed. Oral health status of children with autistic disorder in Chennai. European Archives of

Paediatric Dentistry. 2012 June; 13(3): 131.

74

Ibid., p. 130.

75

J. Shapira, Mann and I. Tamari. Oral health status and dental needs of an autistic population of children and young adults.

Special Care in Dentistry. 1989. 9: 39.

76

Leslie Stephens letters to Julia Jackson Stephen (LS/JJS) 1884; in Love, p. 162.

77

Earlswood Casebook, ref. SCH392/11/4/4, Oct 1894.

78

Newman, pp. 10-11.

It is possible that the domestic turmoil in young Lauras home - both immediately after her mothers
death as well as in her new home with stepmother Julia where Leslie was becoming indignant at her
behaviour - affected her mental state causing her misbehaviour. The extracts from Leslie Stephens letters
to Julia (as cited by Jean O. Love) show that he felt his daughters behaviour was perverse. The irrelevant
remarks Laura made were, for her father, with the most provoking good temper while her howling and
shrieking were to him fiendish bursts of temper, dreadful fits of passion.79 As Lee writes, to Leslie Stephen
she was extremely disturbing and extremely pathetic.80
The notion of misbehaviour is questionable, however, if we argue that Laura had autism all along.
Specifically, the reports of her frequent queer squeaking and semi-stammering, her straining and boggling
over words and the lockjaw way of talking81 during her teenage years concur with the sounds autistic
individuals often display.82 Lauras father and her stepmother were finding it increasingly impossible to cope
with her delayed development during her teenage years at home. Laura was proving unable to learn
behaviours expected by her parents. Indeed, following her subsequent hospitalisation at Earlswood, her
clinical notes stated that although Lauras memory was good, her ability at imitation was classified as not
good. This is again commensurate with one of the common deficits of those on the autistic spectrum. They
display lack of motor imitation, have difficulty copying the behaviours of others and will rather rote-learn
desirable behaviours.83
Because of the obvious signs of a developmental disability, Leslie and Julia decided to have Laura
institutionalised. Upon her admission to Earlswood Asylum in 1893, Laura Stephen was diagnosed as an
imbecile but by the 1901 census she was described as a lunatic; this admittedly presents us with some
incoherence. David Wright describes the difference between a lunatic and an idiot in Victorian eyes in the
following way:
Lunatic referred to all those, though previously sane, suffered from a temporary or permanent
impairment of mental abilityTo use a common, if unkind, distinction made by the Victorian, lunatics
were individuals who had a mind and lost it; idiots were individuals who never had a mind at all.84

79

Leslie Stephens letters to Julia Jackson Stephen (LS/JJS) 1877; in Love, p. 162.

80

Lee, p. 101.

81

Leslie Stephens letters to Julia Jackson Stephen (LS/JJS) 1885; in Love, p. 162.

82

Bravo Oro et al, p. 416.

83

Ibid., p. 418.

84

D. Wright. Mental disability in Victorian England: The Earlswood Asylum 1947-1901. Oxford: Clarendon Press, 2001, p. 58.

Wright and Digby note that the demand for greater clarification between idiots and lunatics was the intention
behind the Idiots Act of 1886.85 However, the Lunacy Act of 1890 completely overlooked this distinction,
continuing to treat the terms idiot and lunatic as synonymous and using them interchangeably.86
Rebecca Poal indeed wonders how one graduates from not having a mind at all to having a mind and
then losing it.87 At this, Newman suggests that these facts indicate the co-existence of two rather different
mental states. On the one hand, Laura had a learning disability with which she had been born; her admission
papers in the Earlswood notes conjecture that she had been an imbecile from an early age and would be for
her entire life. This was part of who Laura was, and was not an illness. However, in addition to this, she
developed a psychotic condition when she was in the asylum, which was an illness. This, for Newman, had
its onset during her early twenties.88
While we agree that Laura did have a developmental disability since birth, we would question that the
psychosis Newman describes developed only when Laura was in the asylum. Victoria Olsen reports that
letters from family visitors to Cornwall - before Laura was admitted to Earlswood - describe her as howling
through the night.89 While at Earlswood in later years, reports like [she] is still very noisy and incoherent90
or [a]t times shouts out and gesticulates91 show continuing symptoms of distress. These behaviours would
confirm a diagnosis of autism and a co-morbid psychotic condition, explaining increased behavioural
problems and grief.92 Stahlberg et al have written about the incidence of psychotic behaviours as being more
frequent in those with autism spectrum disorders than had previously been assumed. The researchers refer
to both bipolar disorder manifestation symptoms such as mood swings and psychotic symptoms during either
depressive or manic phases, as well as symptoms of schizophrenia such as hallucinations, delusions or
confusion.93 In addition to the increased incidence of co-morbidity, autistic individuals with intellectual
disabilities may not have the language or social skills to communicate unhappiness verbally; Laura did not
have a voice. Individuals with autistic spectrum disorders and co-morbid psychiatric disorders, which we

85

D. Wright and A. Digby A. (Eds). From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities.

London: Routledge 1996, p. 142.

86

Ibid., p. 34.

87

R. Poal. Review of Laura Stephen: A Memoir. In Virginia Woolf Bulletin. Issue 15, May 2007: 60-61.

88

Newman, p. 27.

89

V. Olsen. Looking for Laura. Open letters monthly: an arts and literature review. Available online:

http://www.openlettersmonthly.com/looking-for-laura/ Accessed: 21/10/2013.

90

Earlswood Casebook, ref. SCH392/11/4/4, 8th Sep 1894.

91

Ibid., 12th Nov 1984.

92

S. R. Kring, J. S. Greenberg and M. M. Seltzer. Adolescents and adults with autism with and without co-morbid psychiatric

disorders: differences in maternal well-being. Journal of Mental Health Research in Intellectual Disabilities. 2008 April 1; 1(2): 55.
93

O. Stahlberg, H. Soderstrom, M. Rastam et al. Bipolar disorder, schizophrenia and other psychotic disorders in adults with

childhood onset AD/HD and/or autism spectrum disorders. Journal of Neural Transmission. 2004; 111: 892.

argue Laura probably suffered from, have been shown to exhibit significantly higher levels of unpredictable
behaviours.94

d. Social interactions
Extending the discussion of Lauras behaviour to an examination of her social interactions leads us to such
clinical notes - from the Earlswood Asylum - which report that she was usually upset and cries when visited.95
She was also talking wildly to herself and was restless and wakeful at night.96 These entries show an
individual who preferred to retreat to herself, to favour aloneness over socialisation with others, a
characteristic of autism. In his 1943 pioneering study of 11 children suspected of suffering from autism, Leo
Kanner stressed this extreme autistic aloneness that, whenever possible, disregards, ignores and shuts out
anything that comes from the outside.97 More recent research shows that individuals with autism are
attachment-seeking. They lack the social and communication skills to create, develop and maintain satisfying
social relationships.98
Even so, Jean O. Love has argued that the perverse behaviour Leslie Stephen saw in Laura was
childhood schizophrenia. For her, it cannot be discounted that Laura inherited a potential for schizophrenia
from her grandmother, Isabella, and certain genetic pre-dispositions to mental illness from both parents too.
For example, her fits of temper resembled distorted and grotesque imitations of Leslies tantrums, and the
reason for them was no doubt the trauma of losing her mother.99 Love adds comment from Quentin Bells
biography on Virginia Woolf in which he writes:
during Leslies bereavement following Minnys death, he became more aware that the child was
not only slow, that she may have inherited her grandmothers madness, and that Lauras mother
had known of her backwardness.100
Hermione Lee uses the same evidence to suggest that Laura no doubt had an intellectual disability, with
which we agree, and was in addition traumatised by the early loss of her mother and the move into the new
household. Leslie Stephen has indeed been criticised for his intolerance of Laura, and indicted for brutality
and sadism, but for Lee he perhaps retrospectively developed a belief that she inherited a mental condition
from her grandmother, Isabella Thackeray, in order to deny the possibility that she might have inherited any
94

Kring et al, p. 59.

95

Earlswood Casebook, ref. SCH392/11/4/4, 8th Feb 1894.

96

Ibid., 22nd May 1894.

97

Kanner, p. 243.

98

S. Ozonoff and M. South. Social development in autism. In: J. G. Bremner and A Fogel, eds. Blackwell Handbook of Infant

Development. London: Wiley-Blackwell, 2008: 568.

99

Love, p. 164.

100

Q. Bell. Virginia Wool: A Biography. 2 vols. New York: Harcourt, Brace, Jovanovich, 1974, p. 12.

mental instability from him, and to absolve himself from charges of cruelty.101 Hermione Lees reading of the
evidence suggests not a sadistic patriarchal conspiracy, but an unimaginative and disciplinarian response to
the dilemma of caring for a child who was suffering from a mental disability, possibly a form of autism.102 This
is also Caramagnos interpretation of Lauras condition, one of psychosis or autism rather than mental
retardation, which may have been inherited from either side of the family.103 Leslies forceful attempts to
educate and normalise Laura may have exacerbated her condition. His own thin-skinned temper and his
demanding attitudes to women evidently played a damaging part.104 Overall, Leslie Stephen seems to have
been confused, emotional and incompetent, rather than vicious.
The diagnosis of feeble-mindedness and idiocy with which Laura was formally diagnosed, on the one
hand, and that of childhood schizophrenia, on the other, are not a million miles apart but diagnoses one would
expect at the time. Indeed, in his 1943 study Kanner explains how

It is quite possible that some such children have been viewed as feebleminded or schizophrenic. In
fact, several children of our group were introduced to us as idiots or imbeciles.105
He accepts that such symptoms like obsessive behaviour and tantrums, stereotypes and echolalia are
aligned with some of the basic psychotic phenomena. However, he also distinguishes the most plausible
diagnosis of autism from the implausible suggestion of schizophrenia. The children Kanner and his group
examined had all shown their extreme aloneness from the very beginning of life; this was not withdrawal from
formerly existing participation.106 Whats more, while a person with schizophrenia seems to step out of a world
of which he has been a part and with which he has been in touch, the children in Kanners study were able
to establish and maintain an excellent, purposeful, and intelligent relation to objects that did not threaten to
interfere with their aloneness; they were able to extend cautious feelers into a world in which they had been
total strangers from the beginning.107
In Lauras case, any physical contact, including visits from relatives like Julia Stephen while at
Earlswood, threatened to disrupt her aloneness. At the same time, her progressive happiness in institutions
outside her home whether at Miss Searles house where she spent many months of the year during her
childhood, or in Brook House where she was moved - suggest that Laura did not feel a close attachment to

101

Lee, p. 103.

102

Ibid.

103

Caramagno, p. 111.

104

Lee, p. 103.

105

Kanner, p. 242.

106

Ibid., p. 243.

107

Ibid., pp. 248-49.

members of her immediate family; she did not miss them or notice that she lived away from them, but was
happy to lead her life outside her own family.

e. Sexual abuse: autism and co-morbid psychosis

In 1921, when Laura was fifty-one, Lee reports that she was apparently the same as ever, and never stops
talking, and occasionally says, I told him to go away or Put it down, then, quite sensibly; but the rest is
unintelligible.108 Quite detached from the diagnosis of imbecility, the critic Louise De Salvo has speculated
that Laura was abused by the Duckworth boys, and the phrase I told him to go away, forty years later, was
a message to that effect. The critic believes that what had happened to her included the use of force, the
use of violence, and the use of drugs. Lauras childhood was a time of extreme neglect, emotional
deprivation, and abandonment; her life became one of torture and abuse.109
We support De Salvos sexual abuse hypothesis. The only actual records in existence about Lauras
mental state are from The Earlswood Asylum, in which she repeatedly talked to herself about boys and her
family and boys + being in bed + her family when she was most distressed. The clinical notes in the
Earlswood Casebook state that these are disconnected matters.110 However, they are repeatedly connected
by Laura herself, when she is most traumatised. Sufferers of autism frequently have co-morbid mental health
problems, which often revolve around anxiety, and Lauras symptoms certainly seem to agree with this. If we
assume that Laura had autism, the incident of sexual abuse at an early age could have caused a co-morbid
psychiatric disorder, explaining her psychotic behaviour. Anxiety and fear became consequences of her
autism in combination with her psychosis.111

THE END
We sought in this paper to examine the figure of Laura Makepeace Stephen in order to suggest a different
hypothesis for her mental health condition to those made thus far, based on symptoms she is recorded to
have displayed in her fathers letters and other writings, in Virginia Woolfs own writings, as well as in clinical
notes from The Earlswood Asylum for Idiots. A diagnosis of autism with a co-morbid psychotic condition are
consistent with Lauras symptoms of poor oral health, her difficulty with sleep, her repetitive and asocial
behaviour.
The first census with data relevant to Laura following her birth in 1870 was conducted in 1891 and
showed she was simply a boarder at Miss Searles household. The census of 1901 recorded Laura as a

108

Lee, pp. 102-3.

109

De Salvo, p. 36.

110

Earlswood Casebook, ref. SCH392/11/4/4, 29th July 1894.

111

Qian and Lipkin, p. 7.

boarder at Brook House and an imbecile; data that was repeated in the next available census, that of 1911
(see fig 3; fourth entry).

Figure 3. Census of England and Wales, 1911.

Unfortunately, data from the 1921 census is not yet available. This is the only remaining census which will
store data about Laura Makepeace Stephen. The 1931 census was destroyed by fire and no census was
taken in 1941 due to the World War II. What we have already does evidence, however, that attempts to
diagnose Laura did not progress or evolve in any way over time, though, equally, the entry for the 1911 of
Laura as an imbecile rather than a lunatic as in the 1901 census could suggest that her psychotic symptoms
had abated at that time, perpetuating a misdiagnosis for her condition and any potential treatment she could
have received. This, we feel, could be the core reason why Laura has remained in obscurity in the field of
medical humanities research.

Laura suffered from autism and an intellectual disability, and had probably

experienced trauma from sexual abuse by the Duckworth boys, similarly to Virginia Woolf. According to
Hebron and Humphrey, individuals with autism are particularly and highly vulnerable to bullying and abuse.112
It would seem that the trauma suffered by Laura caused her to display psychotic symptoms at times.
Brook House, the last place to which Laura was moved by her family, did not endure for all of her
lifetime. After having been there a little over a year, Leslie Stephen appeared to have forgotten or disowned
his eldest daughter. The same stood for the younger children born of Leslie Stephens second marriage.
Following the extension of the Piccadilly line to Southgate in 1931, the Corner family moved to a farm in
Sandridge, near St Albans, taking Laura with them.113 Dr Corner and his long-term patient Laura Stephen
both died in 1945. He was eighty-one and she was seventy-four. Laura Stephens death certificate indicates

112

J. Hebron and N. Humphrey. Exposure to bullying among students with autistic spectrum conditions: A multi- informant analysis

of risk and protective factors. Autism. 2013 25 July; 0 (0): 2. Available online:
http://aut.sagepub.com/content/early/2013/07/23/1362361313495965 Accessed 6/1/2014.
113

Newman, p. 35.

that she died on February 9th 1945 at the Priory, Roehampton. The cause of her death was an intestinal
obstruction due to a primary carcinoma of the small intestine. The death was recorded after a post mortem
without an inquest. As so much of her life had been lived away from her family, so apparently her exit from it
was made without any of them being aware.114
Although Lauras life has been to date hidden from the public gaze and there has been no coherent narrative
in scholarly papers regarding her mental health conditions, it seems to us that a congenital intellectual
disability in combination with intermittent psychotic symptoms - possibly caused by childhood sexual abuse
in her family context - constitute a more plausible diagnosis. We fully acknowledge that this paper presents
limitations in that it attempts to propose a diagnosis for a deceased individual, who lived long before
developments in autism or psychosis research were in place and for whom the practice of applying any
diagnostic tools whether via interviews, behavioural observations, or other testing evaluations has been
impossible; in such respects, it is therefore hypothetical. Yet, the aim has not been to offer a definitive
diagnosis for her condition; rather, to suggest that perhaps claims made to date within literary criticism fail to
make use of research within psychiatry and the existing clinical notes from the Earlswood Asylum which could
help explain so much more about Laura. The field of medical humanities serves to do just that and we hope
that it will also serve to bring Laura Makepeace Stephen out of obscurity.

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