Andrew T. Scull. Madness: A Very Short Introduction. Oxford: Oxford University Press, 2011. xvi + 134 pp. $11.95 (paper), ISBN 978-0-19-960803-4.
Reviewed by Jordan Piper (Leeds Trinity and All Saints College)
Published on H-Disability (June, 2014)
Commissioned by Iain C. Hutchison
This book forms part of series by Oxford University Press, described as stimulating ways into new subjects. The book may be concise, but it contains a wealth of detailed information written in an engaging manner. No previous knowledge of the subject is required and the reader is quickly drawn into the book.
Scull begins the first chapter by stating that madness is something that has always frightened and fascinated society. He asserts that the use of the word “madness” is now unacceptable. It is therefore interesting that he chooses this word as the title of the book, perhaps to attract interest and create an immediate reaction. The fear of mental illness continues to the modern day and Scull writes that this has always been so. The treatment and management of those with mental illness have changed throughout the ages, but society's fear has not. There are impactful and thought-provoking statements throughout the book. Scull is constantly challenging the reader to consider the subject.
Scull concentrates on madness in the Western world, from the ancient Greeks to the present day. He remarks that there is no single diagnosis to separate the sane from the mad, a fact which goes some way to explain society’s fascination with it. Indeed, it could happen to us all and thus people are afraid of it. Early depictions of madness are found in Shakespeare and continued as a theme in literature. William Hogarth’s (1697-1764) paintings included depictions within Bedlam. Scull sets the scene with some early descriptions of the lives of the insane, for whom care was provided primarily by the church or the family.
The mass confinement of the insane within asylums is described with much derision, including the public visiting Bedlam where the inmates could be viewed as though in a zoo, the Victorian attempts to cure madness through experimentation, and the mentally ill murdered during the Nazi holocaust. Scull is critical of the asylum era. He describes it as “utopianism” in the United States where there was a “cult of curability” in the 1820s and 1830s (p. 46). The mania for asylum-building occurred all over western Europe and North America. The optimism was present throughout Europe and it is apparent that many thought this would end the social problem of madness. This period culminated in the eugenic movement, “the ‘science’ of good breeding” (p. 62). Legislation was introduced in many American states which forbade the mentally ill to marry, and later enforced sterilization. Such science was built upon by Adolf Hitler (1889-1945), who orchestrated the mass extermination of the mentally ill--those with “useless lives” (p. 64).
The treatment of mental illness progressed during the nineteenth century. Scull states that the German doctor Wilhelm Griesinger (1817-68) linked research and teaching when he became the director of a Zurich asylum in 1860. It was believed that there was a link between brain disease and mental illness, but research into this led nowhere. The treatment of patients with hysteria as a biological condition changed with the work of Sigmund Freud (1856-1939), who tried to find meaning in madness. The twentieth century saw the development of the lobotomy and electric shock therapy. Egas Moniz (1874-1955) won the Noble Prize for medicine in 1949 for use of the lobotomy. Again, there was much optimism that a solution had been found, but by the 1960s this operation was seen as brutal and barbaric and was almost completely withdrawn from use.
The final chapter describes the change in treatment from incarceration in the asylum to control through medication and the development of psychoanalysis. The experiments on patients who had no civil rights is a reminder of the eugenics movement. Scull concludes the chapter by identifying the current situation where psychiatrists prescribe Prozac rather than counseling, while there are those who would have benefited from the limited support and care of the Victorian institution but have been cast out. The legacy of this will obviously continue to evolve.
The illustrations are well chosen and impactful. Scull has chosen to include, among others, a photograph of the staff at Hadamar Nazi death camp smiling at the camera; a picture of John Norris, a man incarcerated at Bedlam so that he could not move more than a foot; a doctor about to perform a transorbital lobotomy (using a mallet and small ice-pick device) at the Western State hospital, Washington, in 1949; and a twentieth-century advert for Thorazine, one of the first antipsychotic drugs. Scull also includes paintings from John Everett Millais (1829-96) and Edgar Degas (1834-1917). Reference is made to the appearance of mad women in Victorian literature, for example Charlotte Bronte’s Jane Eyre (1847) and Wilkie Collins’s The Woman in White (1859). The depiction of madness in art and literature through the ages is a useful accompaniment to the history told by Scull whereas the photographs and illustrations provide a frighteningly real insight into the past.
The book is incredibly well researched and is an excellent gateway to the subject. The sources used are vast. The only criticism is that Scull’s obvious derision and often sensationalist rhetoric can distract from the facts. He does not make any allowance for the benefit of hindsight and the book is a scathing description of the ways the mentally ill have been treated. Academic interest in the history of disability is growing at a steady pace and it is likely that one day it will be equal to the history of gender and race. Reading this book would be a huge benefit to students of disability history and medicine or those who have any interest in the subject. The book gives the reader much to consider and may even change their perception of those with mental illness.
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Jordan Piper. Review of Scull, Andrew T., Madness: A Very Short Introduction.
H-Disability, H-Net Reviews.
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