Harriet Washington is a science writer with an argument to make. She argues that mental illness is closely associated with contagious diseases, and that the causes of mental illness are sometimes, partly, germs. She also makes a sociological claim about psychiatry and medicine: it has long resisted acknowledging this side of mental illness, and as a result, many possible ways to decrease the problem of mental illness are being overlooked. She argues that there needs to be a paradigm shift In psychiatry to make room for these ways of understanding mental illness. She also in the later stages of the book expands her claims to include social problems such as violence and war as being related to the levels of infectious disease in society.

It is a feature of psychiatry that nearly everyone championing a theory of mental illness believes that their approach needs to be central to the discipline and that it is unwisely neglected by those in power.  It is somewhat odd to suggest in 2015, when the brain is at the center of the discourse of psychiatry, that a biological approach to the cause of mental illness has been neglected or that psychiatry needs a paradigm shift to include the role of infectious disease. Washington does present some strong evidence that some mental illnesses are made more likely by infectious disease, and she has some excellent discussion of the relevance of twin studies to the genetic nature of mental illness. She also presents strong evidence that in rare cases, infectious disease can be the entire cause of medical problems with the symptoms of mental illness. She does not address the more metaphysical question of whether those conditions are actually mental illnesses, or whether they just look like them. The cautious reader is left with the impression that there are many good reasons to take seriously the role of infectious disease in causing psychiatric problems, and it should be a subject of further research.  It’s far from clear, however, that infectious disease needs to be at the heart of our approach to understanding mental illness.

The unabridged audiobook is performed by Robert Petkoff, who sounds authoritative and enthusiastic. His reading makes it easy to get through the book, which is an achievement for most such non-fiction, when with the hard copy one will often browse quickly through those pages which don’t hold one’s attention.

This is an informative book, with chapters on germ theory, pregnancy, anorexia, OCD, and Tourettes, the role of the stomach and intestines, microbes and culture, problems with antibiotics and ways to overcome infections, and mental illness in the developing world. The chapters of the hardcopy version are footnoted carefully, and sources are carefully cited. Washington writes well, introducing her topics through many personal stories and explaining technical ideas. Infectious Madness may not justify the paradigm shift it calls for, but it is certainly worth reading.

© 2016 Christian Perring

Christian Perring, Professor of Philosophy, Dowling College, New York