Madness: A Brief History (20 page)

At the dawn of the twenty-first century, a similar confusion of tongues may be heard regarding the psychiatric balance sheet. For some, the twentieth century brought Freud’s revelation of the true dynamics of the psyche; for others, psychoanalysis proved a sterile interlude, before neurophysiological and neurochemical understanding of the brain finally advanced and bore fruit in effective medications. Psycho-pharmaceutical developments certainly allow psychiatry itself to function better, but pacifying patients with drugs hardly seems the pinnacle of achievement and any claims as to the maturity of a science of mental disorders seem premature and contestable—witness the wholesale comings and goings of disease classifications from
The Diagnostic and Statistical Manual
.

The psychotropics revolution, the patients’ rights movement, and the scandal of crumbling asylums fused to launch the ‘decarceration’ policies favoured since the 1960s. The difficulties that followed are all too familiar. Controversy rages, within and beyond the profession, about the success (or failure) of deinstitutionalization and community care, leading to calls (from both the profession and the public) to bring back the traditional asylum as a safe haven for the insane. In such circumstances, psychiatry itself may seem somewhat disoriented. Meanwhile, whether treatment of the mentally ill actually became more humane in a century which gassed tens of thousands of schizophrenics is a question permitting no comforting answers about rationality and sanity.

Once under siege from anti-psychiatry
à la
Laing, the discipline has undoubtedly weathered that storm. But it still lacks the cognitive and professional unity enjoyed by general medicine and remains torn between biopsychosocial and medical models both of its object and of its therapeutic strategies.

Meanwhile, partly because of the proliferation of psychiatries, more people are said to be suffering—indeed
claiming
to be suffering—from a proliferation of psychiatric syndromes, in a ‘victim culture’ in which benefits may appear to lie in buying into psychiatric paradigms. More people than ever swallow the medications, and perhaps even the theories, which psychiatry prescribes, and attend various sorts of therapists, as the idioms of the psychological and the psychiatric replace Christianity and humanism as the ways of making sense of self—to oneself, one’s peers, and the authorities. Yet public confidence in the psychiatric profession is low, as is evident from the ubiquitously distrustful images in the arts and reports in the popular press. Is Folly jingling its bells once again?

The last generation has brought a vast proliferation of publications in the history of psychiatry. Much is based upon deep analysis of archival materials (for instance, hospital and institutional records). Much is also, explicitly or not,
parti pris
and polemical; and lively—not to say vitriolic—controversies rage in books and scholarly journals, generally between (alleged) supporters and (alleged) opponents of the established psychiatric enterprise. It would not be appropriate in this brief guide to explore such allegiances in any detail. Mark Micale and Roy Porter (eds.),
Discovering the History of Psychiatry
(New York and Oxford: Oxford University Press, 1994) offers extended critical bibliographical and historiographical essays for materials published up to the early 1990s. For evaluation of monographs published since then, consult the reviews section in such periodicals as
History of Psychiatry
and
Journal of the History of the Behavioral Sciences.

In the following listing, scholarly articles have, on the whole, been omitted for the sake of brevity, and I have also concentrated almost exclusively on English-language material. I have further chosen to omit the enormous recent literature in the fields of literary theory, women’s and cultural studies, and body history which deploys Freudian and Lacanian perspectives to explore the construction of the self: it is beyond the scope of this book.

Chapter 1: Introduction

The best, up-to-date, readable history of psychiatry is Edward Shorter’s
A History of Psychiatry. From the Era of the Asylum to the Age of Prozac
(New York: Wiley, 1997). Its historical prejudices are plain to see. Older works include Franz G. Alexander and Sheldon T. Selesnick,
The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present
(London: George Allen & Unwin, 1967), which is psychoanalytically slanted. Brief is E. H. Ackerknecht,
A Short History of Psychiatry,
2nd edn, trans. Sula Wolff (New York: Hafner, 1968), and briefer still is William F. Bynum, ‘Psychiatry in Its Historical Context’, in M. Shepherd and O. L. Zangwill (eds.),
Handbook of Psychiatry,
vol. i :
General Psychopa,thology
(Cambridge: Cambridge University Press, 1983), 11-38. The history of clinical psychiatry and its concepts is addressed in G. E. Berrios,
History of Mental Symptoms
(Cambridge: Cambridge University Press, 1996) and German Berrios and Roy Porter (eds.),
A History of Clinical Psychiatry. The Origin and History of Psychiatric Disorders
(London: Athlone, 1995).

Various anthologies afford introductions to primary texts. These include John Paul Brady (ed.),
Classics of American Psychiatry: 1810-1934
(St Louis: Warren H. Green, Inc., 1975); Charles E. Goshen,
Documentary History of Psychiatry: A Source Book on Historical Principles
(London: Vision, 1967); Richard Hunter and Ida Macalpine,
Three Hundred Years of Psychiatry: 1535-1860
(London: Oxford University Press, 1963); and Bert Kaplan,
The Inner World of Mental Illness
(New York: Harper & Row, 1964).

Useful works of reference are John Howells (ed.),
World History of Psychiatry
(New York: Bruner/Mazel, 1968); and John G. Howells and M. Livia Osborn,
A Reference Companion to the History of Abnormal Psychology
(Westport, Conn.: Greenwood Press, 1984).

On the question, mooted in this Introduction, of the reality of mental illness, see Thomas S. Szasz,
The Manufacture of Madness
(New York: Dell, 1970; London: Paladin, 1972);
idem, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct
(rev. edn., New York: Harper & Row, 1974); and
idem, The Age of Madness: The History of Involuntary Mental Hospitalization Presented in Selected Texts
(London: Routledge & Kegan Paul, 1975); see also Michel Foucault,
La Folie et la Déraison: Histoire de la Folie à l’Age Classique
(Paris: Librairie Plon, 1961); abridged as
Madness and Civilization: A History of Insanity in the Age of Reason,
trans. Richard Howard (New York: Random House, 1965)—the most searching analysis of the symbiotic histories of reason and unreason. For critical discussion, see Arthur Still and Irving Velody (eds.),
Rewriting the History of Madness: Studies in Foucault’s ‘Histoire de la Folie’
(London and New York: Routledge, 1992), and Martin Roth and Jerome Kroll,
The Reality of Mental Illness
(Cambridge: Cambridge University Press, 1986). Klaus Doerner’s
Bürger und Irre
(Frankfurt-am-Main: Europäische Verlaganstalt, 1969) English trans.:
Madmen and the Bourgeoisie: A Social History of Insanity a.nd Psychiatry
(Oxford: Basil Blackwell, 1981) follows a similar trail to Foucault.

Recent studies which historically illuminate the question of the reality, persistence, or transience of mental illnesses are Ian Hacking,
Mad Travellers: Reflections on the Reality of Transient Mental Illnesses
(London: Free Association Books, 1999) and Walter Vandereycken and Ron Van Deth,
From Fasting Saints to Anorexic Girls: The History of Self-Starvation
(London: Athlone Press, 1994).

Chapter 2: Gods and demons

For madness and the gods in Greek culture, see Bennett Simon,
Mind and Madness in Ancient Greece
(Ithaca, NY: Cornell University Press, 1978) and Ruth Padel,
In a.nd Out of the Mind:

Greek Images of the Tragic Self
(Princeton: Princeton University Press, 1992). For the supernatural and the psyche in the Middle Ages, consult Penelope E. R. Doob,
Nebuchadnezzar’s Children: Conventions of Madness in Middle English Literature
(New Haven and London: Yale University Press, 1974), and Basil Clarke,
Mental Disorder in Earlier Britain
(Cardiff: University of Wales Press, 1975). Particular early modern contexts are examined in Michael MacDonald,
Mystical Bedlam: Madness, Anxiety and Healing in Seventeenth Century England
(Cambridge: Cambridge University Press, 1981);
idem, Witchcraft and Hysteria in Elizabethan London: Edward Jorden and the Mary Glover Case
(London: Routledge,

1991), and H. C. Erik Midelfort,
A History of Madness in Sixteenth Century Germany
(Stanford, Calif.: Stanford University Press, 1997). Gregory Zilboorg’s
The Medical Man a.nd the Witch During the Renaissance
(Baltimore: Johns Hopkins University Press, 1935) is provocative but dated.

Far the best account of the rational critique of demonology is Michael Heyd,
‘Be Sober and Reasonable ’, The Critique of Enthusiasm in the Seventeenth and Early Eighteenth Centuries
(Leiden; New York; Köln: E. J. Brill, 1995).

For George Trosse, see
The Life of the Reverend Mr. George Trosse: Written by Himself, and Published posthumously According to His Order in 1714,
ed. A. W. Brink (Montreal: McGill-Queen’s University Press, 1974).

Chapter 3: Madness rationalized

The humoralist tradition within which theories of mania and melancholy were situated is explained in James N. Longrigg,
Greek Rationa.lMedicine
(London: Routledge, 1993); E. D. Phillips,
Greek Medicine
(London: Thames & Hudson, 1973); and V. Nutton, ‘Humoralism’, in W. F. Bynum and Roy Porter (eds.),
Companion Encyclopedia of the History of Medicine
(London: Routledge, 1993), 281-91. For ancient ideas about madness, see G. A. Rocca-tagliata,
A History of Ancient Psychiatry
(Westport, Conn.: Greenwood Press, 1986). For later developments of such views, S. W. Jackson’s
Melancholia and Depression: from Hippocratic Times to Modern Times
(New Haven: Yale University Press, 1986) is excellent.

For the Islamic tradition, consult Michael W. Dols,
Majnun: The Madman in Medieval Islamic Society
(Oxford: Clarendon Press,

1992); medieval Western ideas are explored in Nancy G. Siraisi,
Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice
(Chicago and London: Chicago University Press,

1990). And for Renaissance thinking see Andrew Wear, Roger French, and Iain Lonie (eds.),
The Medical Renaissance of the Sixteenth Century
(Cambridge: Cambridge University Press, 1985).

The best scholarly edition of Robert Burton’s
The Anatomy of Melancholy
is that edited by N. K. Kiessling, T. C. Faulkner, and R. L. Blair (Oxford: Oxford University Press, 1990); on Burton see L. Babb,
Sanity in Bedlam: A Study of Robert Burton’s Anatomy of Melancholy
(East Lansing, Mich.: Michigan State University Press, 1959) and Berger Evans,
The Psychiatry ofRobert Burton
(NewYork: Octagon Books, 1972).

For the new seventeenth-century turn in psychiatric thinking, see T. Brown, ‘Descartes, Dualism and Psychosomatic Medicine’, in W. F. Bynum, Roy Porter, and M. Shepherd (eds.),
The Anatomy of Madness,
vol. i (London: Tavistock, 1985), 151-65. Also good on Descartes is R. B. Carter,
Descartes’ Medical Philosophy: The Organic Solution to the Mind-Body Problem
(Baltimore: Johns Hopkins University Press, 1983). Interesting on Hobbes is Jeffrey Barnouw, ‘Hobbes’s Psychology of Thought: Endeavours, Purpose and Curiosity’,
History of European Ideas,
x (1990), 519-45» while for Locke consultJohn W. Yolton,
John Locke and the Way of Ideas
(Oxford: Oxford University Press, 1956).

Chapter 4: Fools and folly

On madness and stigma see Erving Goffman,
Stigma: Notes on the Management of Spoiled Identity
(Harmondsworth: Penguin, 1970); Sander Gilman,
Difference a.nd Pathology
(Ithaca, NY, and London: Cornell University Press, 1985); and
idem, Disease and Representation. From Madness to AIDS
(Ithaca, NY: Cornell University Press, 1988). For images of the mad—and also for the art of the insane—see Sander L. Gilman,
Seeing the Insa.ne
(New York: Brunner, Mazel, 1982) and J. M. MacGregor,
The Discovery of the Art of the Insane
(Princeton: Princeton University Press, 1989).

A survey of literary renderings of madness is offered by L. Feder,
Madness in Liternture
(Princeton: Princeton University Press, 1980); for the early modern period, Robert S. Kinsman, ‘Folly, Melancholy and Madness: A Study in Shifting Styles of Medical Analysis and Treatment, 1450-1675’, in R. S. Kinsman (ed.),
The Darker Vision of the Renaissance: Beyond the Fields of Reason
(Berkeley: University of California Press, 1974), 273-320, and Duncan Salkeld,
Madness and Drama in the Age of Shakespeare
(Manchester: Manchester University Press 1993) are illuminating. Love folly is the theme ofJacques Ferrand’s
A Treatise on Lovesickness
, trans. and ed. D. A. Beecher and M. Ciavolella (Syracuse, NY: Syracuse University Press, 1990), which is evaluated in M. F. Wack,
Lovesickness in the Middle Ages: The Viaticum and its Commentaries
(Philadelphia: University of Pennsylvania Press, 1990). Later literature/madness interfaces are probed in Allan Ingram’s
The Madhouse of Language: Writing and Reading Madness

in the Eighteenth Century
(London/New York: Routledge, 1991), Max Byrd’s
Visits to Bedlam: Madness and Literature in the Eighteenth Century
(Columbia: University of South Carolina Press, 1974), and Michael V. DePorte’s
Nightmares and Hobby Horses: Swift, Sterne, and Augustan Ideas of Madness
(San Marino, Calif.: Huntingdon Library, 1974).