Madness: A Very Short Introduction by Andrew Scull
My rating: 5 of 5 stars

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This is yet another of the many “Very Short Introduction” books from Oxford University Press that I’ve been pleased to read and review. The series offers concise overviews of a wide range of topics that are presented by scholarly experts. This particular book is a historical examination of the changing approaches to mental illness from the ancient world where such a condition might be attributed to demonic possession to more recent times in which drugs and decarceration / defunding of asylums have become the dominant approaches to mental illness. Along the way the book shines a light on the immense difficulty experts have had in understanding what mental illnesses are and how they can best be dealt with. The book not only looks at the real-world response to mental illness, but also explores how it’s been treated in fiction from “Hamlet” to “One Flew over the Cuckoo’s Nest.”

The book consists of six chapters. As one would expect of a book from a historian’s-eye view, its organization is chronological, but the arrangement of time periods by chapter reflects changing approaches to mental illness. Chapter one focuses on the ancient world, during which we begin to get glimpses of madness in the written record. Chapter two, entitled “Madness in Chains,” focuses on the 16th through 18th century, during which Bethlem [Bedlam] Hospital was the cutting edge. That the institution’s nickname becoming a synonym for chaos and confusion says a lot. It was a time of brutal measures that did little to reduce the trauma of mental illness. The chapter also discusses madness in Elizabethan literature, famously that of Shakespeare.

Chapter three shifts to the 19th century, an era in which incarceration became more widespread as well as coming to be thought of as the best that could be done for the insane. In Chapter four, we learn about the rise of psychoanalysis as well as the increasing employment of treatments that involved the physical body – infamously, the lobotomy.

Chapter five is one of the most intriguing parts of the book. Entitled “Madness Denied” it opens with an exploration of the difficulties that arose from all the war-related cases of mental illness that came about as a result of the two World Wars (and others.) It also discusses a movement to overturn the prevailing approach to insanity, most famously and vociferously argued by the Scottish psychiatrist R.D. Laing, a clinician who had a mix of promising and disastrous results from his experimental approach which used LSD, but few other medicines. What I found most interesting, however, was the discussion of the growing recognition that there was a false front in the idea that psychiatry was beginning to really understand mental illness and its treatment. This was exemplified by the Rosenhan experiments in which sane volunteers checked themselves into asylums and, for the most part, the doctors and staff couldn’t tell that they were sane (though, interestingly, in at least some cases the other patients did call it out.) The troubles in classifying and diagnosing mental illnesses have also seen in the vexed history of the “Diagnostic and Statistical Manual of Mental Illness” [DSM,] a guide meant to get mental health experts on the same page about what’s what. [As opposed to ten psychiatrists offering ten different diagnoses of a given patient.] While a worthy attempt, the DSM has not – thus far – succeeded, though it could probably be argued that progress has been made.

The last chapter brings the reader up to the current period, a period dominated by two trends – first, mental illnesses being treated overwhelmingly pharmaceutically; and second, the closing of asylums and the concurrent ill-effects that have come about, societally speaking.

The book has a few graphics, mostly black and white art and photos used to enhance the reading experience. There are also appendices of references and recommended readings.

If you are interested in the history of psychiatric medicine, I’d highly recommend you check out this brief guide. It may not give you all the information you’re looking for, but it’s a good first stop to organize your thoughts on the subject.

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