Professor Scull has embarked on an ambitious project: tracing the history of “madness” as identified by society, as opposed to “mental illness” as defined by psychiatry. He has succeeded.

Before he begins, Scull explains his choice of title and emphasizes the message behind the title. He distinguishes his work from Michel Foucault’s similarly titled–but subsequently contested–study, Madness and Civilization: A History of Insanity in the Age of Reason. The distinctions between Scull and Foucault extend far beyond the scope of their respective books and far beyond the fact that Foucault was a francophone whereas Scull is a British-born Anglophone who now lives and teaches in America. Foucault’s ken is microscopic whereas Scull’s is macroscopic. Foucault circumscribes his topic and targets the Age of Reason, whereas Scull stretches “from the Bible to Freud, from the Madhouse to Modern Medicine,” as stated in his book’s title.  

That distinction is superficial compared to the attitudinal differences. As Scull explains it, Foucault positioned madness in opposition of civilization, and argued that the Age of Reason strived to suppress madness–or the loss of reason–because the era extolled “reason.”     

In contrast, Scull contends that madness is woven into the tapestry of civilization and is not necessarily set apart from civilization. Different cultures and different societies offered different explanations for madness, and have different ways of dealing with madness. Some societies sanctified perceptions and behaviors that we currently call “madness” while other societies vilified the same behaviors and went so far as to burn suspects at the stake–or to lock them in madhouses, chain them to walls, and leave them to languish in their own filth. Scull points to the “Jews” (who were more correctly called “Hebrews” at a time before the religion known as Judaism evolved). He notes that Hebrew prophets would be deemed mad today and often were derided as psychotic in their own era, especially where they inveighed against their own people.

Professor Scull is a professor of sociology, not a professor of history, although he apparently feels at home in his adopted discipline. He does not present a triumphalist version of this history of madness nor does he express admiration for the “advances” of contemporary psychiatric interventions–not by a long shot. He delves into current concerns with brains, biology and behavior, but convinces us that we have not yet arrived at an idyllic state. Indeed, there is no psychiatric Shangri-La in sight. So-called “progress” has not evolved into perfection–it is simply another stage in the game, and is not necessarily a stepping-stone to something better.

Unlike some sociologists of psychiatry and madness, Scull does not come across as rabidly anti-psychiatry. He avoids name-calling, circumvents polemics, and remains relatively dispassionate when he cities statistics that undermine current treatment trends in psychopharmacology. The data he cites is well known to most practicing and research psychopharmacologists, who regularly encounter related critiques and primary sources in academic psychiatric literature.

While reading the last chapter of Scull’s book, with the tongue-in-cheek title (“A Psychiatric Revolution?”), I wondered if this book would have merited mention in Dr. Marcia Angell’s  provocative New York Review of Books articles from 2011, had it been in print five years earlier. Angell, the one-time editor of the prestigious New England Journal of Medicine, wrote book reviews for NYRB on “The Epidemic of Mental Illness: Why?” and “The Illusions of Psychiatry.” [1] In that series, she dissects damning publications by Whitaker, Kirsch, and Carlat, condemns contemporary psychiatric practice–and spends the rest of the summer responding to rebuttals that appear in July and August issues of New York Review of Books in 2011.

Scull includes some amusing one-liners about traditional pillars of psychiatry. For instance, he tells us that the Menninger brothers “were based in a family business offering psychotherapy in Topeka, Kansas” (page 333). Elsewhere, he notes that Karl Menninger appeared in the cover of Time magazine, but nowhere does he applaud the brothers who provided jobs–and a safe harbor–for displaced, mostly Jewish, European psychoanalysts in flight from Hitler’s reach.

For historians of psychiatry and psychoanalysis, the Menningers are venerated for their role in promoting psychoanalysis in post-war America. For those more inclined toward Jewish history, the Menningers’ willingness to sponsor these soon-to-be stateless Jewish psychoanalysts seemed to be an act of mercy as much as an academic quest for knowledge. Those who contemplate Scull’s subtle quip may rethink the Menningers’ motivations, especially if they are familiar with America’s current J1 visa program that sponsors unlicensed international doctors for low-paid positions in remote American hospitals that fail to attract American medical school graduates.

Scull raises many more questions in his 400+paqe tome, which could easily be split into several shorter books. This massive volume could stand alone as an annotated picture book and nothing but, along the lines of Lynn Gamwell and Nancy Tomes’Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914 (Cornell Studies in the History of Psychiatry) (Cornell University Press, 1995). For the full-color illustrations–all 44 of them–are spectacular in their own right, and prove that pictures do speak a thousand words, and look pretty, too.

Flipping through reproductions of William Hogarth’s monochromatic mezzotints of madmen and madwomen raving in church pews–espousing “enthusiastic religion”–may satisfy many readers. Shakespearean scholars may recognize imagery from Titus Andronicus, reproduced here in B&W, or bookplates from Robert Burton’s 17^th century Anatomy of Melancholy (1621).

For those who want more, there are color plates from Hieronomyous Bosch or photographs of Grecian urns decorated with images of Ajax slaying his son or illuminated medical manuscripts of Avicenna or John Everett Millais’ Pre-Raphaelite painting of the drowned Ophelia, bedecked in flowers after losing her mind. We find kaleidoscopic illustrations of medieval saints who reportedly cured madness–or experienced madness. There is a reproduction of Van Gogh’s The Ward in the Hospital at Arles (1889) and a detail from Peter Breughel the Elder’s rendition of “Mad Meg.” The art of Goya, Durer, Otto Dix, and Richard Dadds appear, and sometimes include portraits of their psychiatrists. These color plates of museum-quality artworks are far more alluring than the more sensationalized images of Walter Freeman at the lobotomy table or copies of pharmaceutical ads–but those documentary photographs are important to the theme.

Somewhat to my surprise, there is no direct mention of George Rosen’s 1968 classic, Madness in Society: Chapters in the Historical Sociology of Mental Illness (University of Chicago, 1968). Besides the similarities in titles, Rosen also earned a Ph.D. in sociology–but not until after completing his M.D. and grounding himself in public health and history of medicine. Those who appreciate Scull’s comprehensive Madness in Civilization might enjoy Rosen’s very different–and much more medicalized–perspective on similar subjects that interface with public health.

 

[1] Marcia Angell, ‘The Illusions of Psychiatry” and “The Epidemic of Mental Illness: Why?” New York Review of Books, June 23, 2011 and July 14, 2011. An Exchange. Reply by Marcia Angell to John Oldham, Daniel Carlat, Richard Friedman, and Andrew Nierenberg, In response to: The Illusions of Psychiatry (July 14, 2011); The Epidemic of Mental Illness: Why? August 18, 2011; John Oldham, M.D., President, American Psychiatric Association. In response to: “The Illusions of Psychiatry” (July 14, 2011); The Epidemic of Mental Illness: Why? June 23, 2011. New York Review of Books. August 18, 2011. 

 

 

© 2015 Sharon Packer

 

Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books includeDreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at drpacker@hotmail.com .