Through the Eyes of Dr Hugh Welch Diamond: Two Portrait Prints of Women Psychiatric Patients

Content warning: This article talks about suicide related experiences and suicidal ideation

When you post a photo of yourself on social media, what do you want it to say about you – maybe your mood or attitude? The two objects from the collection we look at today, Insanity Supervening on Habits of Intemperance (Plate 12) and Suicidal Melancholy (Plate 2), are engraved prints from the photographic portraits of two women who were patients at the Surrey County Asylum about 165 years ago. We cannot be sure if these prints and photos show what these women felt and wanted to express. Rather, they show what the photographer, Dr Hugh Welch Diamond, wanted us to see.

Everything is in the photograph: Diamond and his photographic physiognomy

As an early photography enthusiast and also the superintendent of an asylum in Surrey, Dr Hugh Welch Diamond was the first practitioner to use photography in a way that he believed enhanced the effectiveness of his diagnosis and therapeutic treatments. To him, photographs presented a faithful and accurate medical record.

The Photographer secures with unerring accuracy the external phenomena of each passion, as the really certain indication of internal derangement, and exhibits to the eye the well-known sympathy which exists between the diseased brain and the organs and features of the body

On the Application of Photography to the Physiognomic and Mental Phenomena of Insanity, H.W. Diamond (1856)


Members of the Photographic Society club with H.W. Diamond on the left. Photograph ca. 1856 (c) Wellcome Images
Members of the Photographic Society club with H.W. Diamond seated on the left,1856 (c) Wellcome Images


Diamond believed in something called photographic physiognomy – the inaccurate idea that different features of mental illnesses are expressed in the outer appearance, facial expressions, body gestures, hairstyles and even the outfits of patients, and therefore that photography can capture them. Together with the notes Diamond wrote with John Conolly, a physician at the asylum and fellow of the Royal College of Physicians, these photographs were used to validate Diamond’s diagnosis. At the same time, Diamond took pride in curing his patients by making them look at their own photos.

I [Diamond] wished to possess portraits of the several patients who imagined themselves to be Queens […] and one of these in a dominant attitude and with a band or “diadem” round the head, stands first in the frame. It was however not without much persuasion that I induced [her] to give me the honour of a sitting. Her subsequent amusement in seeing the portraits and her frequent conversation about them was the first decided step in her gradual improvement, and about four months ago she was discharged perfectly cured, and laughed heartily at her former imaginations

Diamond, 1856

Although Diamond interfered with the pose of this patient, she had a certain amount of freedom to decide how she wanted to present herself in front of the camera. Unfortunately, not all of his patients had such a choice.

Insanity Supervening on Habits of Intemperance
Insanity Supervening on Habits of Intemperance (PR15780). Below, we will be looking at the image of the woman on the left, Figure 1

For medical purposes: Insanity Supervening on Habits of Intemperance, Plate 12

Today we may want to edit our photos to make ourselves look better or present ourselves in a certain way. Yet for Diamond, the editing had a practical agenda behind it. The female patient in Plate 12 looks straight into the camera and has a prayer-like pose with her elbows close to the sides of her body, palms together and fingers straight [the woman on the left in fig.1]. The original photograph held at the Royal Society of Medicine, however, looks nothing like this. Though staring at the camera, the woman turns her head 45 degrees to her left in the photograph, which makes her seem like she is showing suspicion and disdain with her frown. Instead of folding her hands, she is placing her left hand on her right hand and pressing them against her chest.   


The edited lithograph print, which looks straighter and more symmetrical, might be the result of the artist’s and photographer’s aesthetic preference. However, it may also be the case that Diamond and Conolly wanted to emphasise the impact of religion on the patients.

Religious activities were a common therapeutic treatment for patients with alcohol use disorder:

'All physical excess is at an end - no neglect and no cruelty add to the morbid wretchedness; kind words are heard, and religious thoughts are gradually introduced into the mind of the sufferers; and the curtain of death falls gently even upon them'.

'The Physiognomy of Insanity' by John Conolly


Afterall, being visual sources published in medical journals and exhibited publicly, these engravings functioned like advertisements. They proved that the asylum’s therapeutic methods worked. The patients became living examples of how Diamond’s photographic physiognomy, Conolly’s advocacy for non-restraint practices in asylums, and religion could help patients regain hope and inner peace.

Suicidal Melancholy, Plate 2
Figure 3: Suicidal Melancholy (PR15582). According to the description by Conolly, this woman, like many of those in the asylum, was considered to be ‘uneducated’ and ‘non-refined’.

Muted in photos: Suicidal Melancholy, Plate 2

What about the authentic voices of the patients? Being described as ‘evidently of lower ranks of life’, this woman in figure 3 was critically analysed by Conolly:

'Some bodily function becomes accidentally impaired [...] Occasional depression of mind ensues, and gradually increases. The patient becomes inactive, abstracted, and silent, and all cheerful expression is banished from the countenance, [...] until at length, on some dreadful morning, the patient first shows a determined tendency to self-destruction'

Physiognomy of Insanity: Suicidal Melancholy by John Conolly


Although he admitted that the lives of working-class women were ‘intimately known to few’ in Conolly’s circle, Conolly attempted to describe the social biography of the woman. To him, poverty was not only associated with malnutrition and bad health, but also alcohol abuse and the deterioration of mental health, especially with the absence of religious faith.

In historic records, the discourses and assumptions of medical professionals are dominant, the voices from those labelled as melancholic, especially the female patient, are scattered. Testimonies of suffering, distress, pains and emotions can only be implied anecdotally or in suicide letters – in the way these women wrote the letters, folded their letter papers, placed their finished letters, addressed themselves and the reader.  Alcohol abuse was believed to be a prevalent social problem in the Victorian era, and was attributed as a cause in many cases of melancholy and suicidal thoughts, but it was certainly not the only reason. For instance, Mary Wainwright Atherstone, wife of the British poet Edwin Atherstone, wrote in her own death note, “I brood & brood ‘till I’m mad. I thank you with my whole heart for all your forbearance to my silly humours – I must have been a bore to you for years.” Mary describes what she feels as the burden of motherhood and a difficult relationship as the reasons for her suicide.

Through Mary’s letter, we can sense the mental anguish and physical pain she was going through:

'[I feel] as if I could scream till it reach’d Heaven or Taunton or Nottingham or all together – my poor head is so hot'


Other suicide notes from the 18th and 19th centuries suggest that headaches were a prominent symptom as well as sleeplessness, a sense of heaviness and lowness, heartache and the wringing of hands.

These testimonies, which form part of the patient narrative, were not studied by historians systematically and thoroughly until recent decades when the discourse of underrepresentation emerges. Even now, this topic remains insufficiently researched. At the same time, it is common to see that these letters invoke many interpretations in different contexts even if they represent the psychiatric patients attempting suicide. For instance, is the 'pain' described above metaphorical or suggestive of real physical symptoms? Or how should we comprehend the words and stories of these writers? On the contrary, the works of Diamond and Conolly explain themselves in a systematic way even if they turn out to be inaccurate. They were properly published, circulated among, and accepted by other medical practitioners at the time who had powerful voices like Diamond and Conolly did. It is not surprising, then, to find that the voices of patients have been overshadowed by that of Diamond and Conolly. In addition, these prints, including Plate12 and 2 introduced in this article, were created from the perspective of Diamond right from the beginning.

No matter how objective the photographs or prints engraved from them seem, they are ultimately about who gets the power to express what they want to say. Just as how you and your friend, with different interests, beliefs, preferences and tastes, may choose to emphasise completely different things in your photos, it is time we ask:

From whose perspective are we looking from when we gaze upon an artwork? What does it tell us? And what does it NOT tell.

Joelle Li

UCL, Student placement


  • Diamond, H.W. (1856). ‘On the Application of Photography to the Physiognomic and Mental Phenomena of Insanity’. Reprinted in PsicoArt – Rivista Di Arte E Psicologia, 1(1). (DOI:
  • Georges Didi-Huberman and Charcot, J.M. (2003). Invention of hysteria: Charcot and the photographic iconography of the Salpêtrière. Cambridge, Mass.: Mit Press. 
  • Conolly, J. (1858). ‘The Physiognomy of Insanity'. In Medical Times & Gazette. London: Reed and Pardon
  • Pearl, S. (2009). ‘Through a Mediated Mirror: The Photographic Physiognomy of Dr Hugh Welch Diamond’. In History of Photography, 33(3). P.290. (DOI:
  • Conolly, J. (1860). Physiognomy of Insanity: Suicidal Melancholy. In Bucknill, J.C.'s (ed.) Asylum Journal of Mental Science, 4. Longman Green Longman & Roberts
  • Sbaraini, E. (2022). ‘The Materiality of English Suicide Letters, c. 1700 – c. 1850’. In The Historical Journal, 65. Pp.612–639. (DOI:
  • Sbaraini, E. (2020). Embodying Suicidal Emotions in England, 1700-1860. [online] Available at: 

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