This very short book gives a glance into the changing perspective on madness. The product of a lifelong of study it demonstrates a vast body of knowledge in the history of science.
To ‘define true madness, is’t but to be nothing else but mad’ Insanity then seems to be the mysteries of mysteries. Szasz controversiallu claimed that ‘there is no such thing as mental illness’ and that it is a myth fabricated by psychiatrists to consolidate their professional posistion, and sanction and legitimize easy solutions for problem people. This was the manufacture of madness through psychiatric labels to social pests, odd or challanging members of society. Along with Szasz, Michel Foucault argues that mental illness is not a natural fact but a cultural construct, madness is a disease of society, sustained by the mental medico-psychiatric infrastructure. The history of madness is not a story of diseas but manipulation of reason, power, freedom and control. In contrast Martin Roth argued that the stability and prevelence of mental illness shows that it is not merely a scape goating device, but a real psychopathological entity, with an organic basis.
Religious Madness
Porter first treats the biblical understanding of madness, wherby madness is seen as punishment from God, as seen in Deut 6:5. The greek tragedies feature madness as the result of the conflict between man and the gods. Shakespeare saw madness as a path of resolution, the madness of king leah and his self-alienation in the end lead to self-knowledge. Madness was a pathway to understanding the self. Christian Madness revolved around the fact that reason was the essence of man, in apocolyptic narrative in which mankind is outnumbered by supernatural beings, the Holy Spirit and devil battling for possession of the soul. This view is seen in the Anatomy of Melancholy, and Richard Napier who saw those of ‘unquiet mind’ were the result of religious despair. Diabolical possession was the sign of a lost soul. Reason was in harmony with God, failure to conform was unreasonable and lead to derengement, madness was a phase in redemption, bringing the sinner to a state of crisis, and preclude to recovery. This also saw the rise of demonic possession and witchcraft with Reginald Scot’s Discovery of Witchcraft and King James’ Daemonologie. Anglicans were cautious about labeling demonic possession for fear of playing into the hands of papists and puritans, and said that they were self-deluding fancies of zealots, who had unhinged their own mind.
The shift in opinion occured after the thirty year war. This was intense religio-political division and as a result the extrem puritans and fringe movements such as Anabaptists, and Ranters were denounced as being brain-sick puffed-up prophets. Doctors started to point out the fact that reigious fringe and lunatics had an affinity; both displayed glossolalia (tongues), convulsions, weepings and wailing. ‘Enthusiasm’ was seen as psychological dillusions. Thomas Willis coined the phrase ‘neurologie’ this excluded the devil, possession now was defects of the brain and nerves. The pathologisation of religious madness lead ENlightenment thinkers to pathologise religiosity as a whole.
Madness Rationalised
Plato and the greek philosophies polarised rationality and irrationality, enshrining the mind over matter. Hippocratic medicine aimed to aid nature in creating and preserving a healthy mind in a healthy body. The galenic theory of humours meant that health was an equilibrium between extremes. Mania was opposed to melancholy. The first work on Melancholy was Timothy Bright, yet it was Robert Burton who provided the conclusive study, which demonstrated that there are as many theories of insanity as there are mad people. The next step in Porter is the role of Descartes, and his glorification of rationality. It was reason alone that would redeem and save mankind from ignorance, confusion and error. Descartes equated mind with incorporeal spirit, he had the problem with locating the mind in space and had to use the pineal gland which linked the body and mind
. Mental disorder accordingly was a problem between the interaction of mind and body. The result was that mental illness was now safely removed from religion and an object for philosophy and medicine
Fools and Folly
All societies judge people as mad, irrespective of any clinical judgement distinguished for devience or danger. This stigmatizing of those who are disqualified from social acceptance, projects social values. This demonised them, whilst excluding any demonic influence. It possible that this demarcation comes from a deep anthropological desire to order the world by catagorising the world and sepereting the self from others. The construction of ‘them and us’ reinforces our fragile sense of self-identity, and self-worth. Thus the creation of the insane at the same time constructs what it is to be sane, the two concepts reinforce each other in mutrally exclusive catagories. It also saw the depiction of madness as a part of genius, it was an attribute and natural part of poet. John Evelyn in his diary saw an inmate of Bedlam reciting verse. Porter observes that ‘ Madness thus donned many disguises and acted out a bewildering multiplicity of parts in early modern times: moral and medical, negative and positive, religious and secular. Bedlam was the new hospital for the mentally ill, that brought the sane and insane into great proximity. ‘the world is a great Bedlam, where those who are more mad, lock up those that are less.’ Folly started to be medicalised. the mad poet or artist was no longer romanticised. Swift saw lunacy as something that could infect dissenters and free-thinkers.
Edward Young’s Conjectures on Original Composition, saw creativity as part of a healthy psyche. This was the Romanticised version where the poet was not pyschologically peculiar but the embodiment of health. The avent-garde of Baudelaire, Flaubert saw that the works of genius were hammered out of the anvil of pain, and the sickness of madness. Likewise, Mary Wollstonecraft depicted the gothic image of the mad, with the popularised image of Ophelia.
Locking up the mad
In this chapter Porter looks at the way in which the mad moved from being treated at home, to religious institutions, through to the creation of Asylums to house the mentally ill. First Plato had said that the mad were the responsibility of the family, this was deeply shamefull due to its diabolical connotations. Michel Foucault argued that the 1660’s in Paris saw the start of the great confinement, and the locking up of the insane in asylums such as Paris’ Hopital General. This was both therapeautic and police oriantated. It cured both the patient and society of the burdon of the mentally ill. A consequence of this Foucault said was that MAdness loss its humanity. It placed the mad poor into bourgeois work ethic. Foucault over simplifies when he casts the rise of psychiatry in functional power relationships, the new witch-hunt for the social deviants. The drive to confine was not the mechanisms of power, or the sovereign, but families and local bodies all sent them to the Asylum. Why did people send patients to Asylums? I think this would be interesting, to study the reasons for confinement.
Psychiatry did not pre-exist Asylums but was instituted in order to manage its inmates. The rise of psychiatry classified insanity into original and consequential, that which was incurable and innate, and that which was triggered by events, this was curable. In the cure most famous was the reforms in Bicetre and Salpetriere by Dr Philippe PInel. He took upon him Enlightenment ideals of equality, liberty and fraternity, and unshackled the inmates, mentally illness was to be relived through mental approaches not physical restraint. A lot of Asylums were criticized, Bedlam was notorious for the treatment, and abuse of its inmates, with many inmates releasing expose’s of malpractice. This criticism did not abolish but reformed the Asylum. These reforms were seen to be through arcitecture. The correct building was a way to reform the mind of the patients, the buildings were in countryside, in order to help reconfigure their natural mental state. Jeremy Bentham’s panopticon. The new reforms meant meticulous classification of the inmates into levels and types of madness.
In sum Porter gives an excellent overview of major elements in psychiatry, in a thematic way that shows the changes. It is an excellent, well written spring board into the vibrant and disturbing history of psychiatry.
