Madness took horrendous toll
One of the most devastating lines in literature is King Lear’s anguished cry of ‘‘O, let me not be mad, not mad, sweet Heaven!’’ To be mad is one of the worst afflictions to happen to a human. It’s an illness that reeks of sadness, alienation, shame, misery and the death of reason.
For British social historian Andrew Scull madness is a phenomenon found in all societies. His vast cultural history of insanity, Madness in Civilization, begins in ancient societies where madness was to be possessed by evil spirits, yet there were also lunatics who were seen as divinely inspired prophets. Ancient Greeks, like the later Romans, believed gods or demons were to blame for madness. Many a Greek playwright was fascinated by the terrible potency of insanity, from Medea’s savage murder of her children to Euripides’s Hera driving Heracles mad: ‘‘Send madness on this man, confound his mind, and make him kill his sons.’’
Scull tries to include countries beyond the West but the paucity of written material means that it’s sketchy at best. For the Chinese, good health was a balance between the opposite qualities of yin and yang, therefore madness was a corporeal and cosmological imbalance. If this seems a vague diagnosis then the Jews, Christians and Muslims of the Middle Ages were of the belief that the cause of mental disorders was supernatural. From that came the idea of exorcism and the ridding of evil demons who possessed the unfortunate lunatic.
It’s at this point in history that Western medicine tried to find a less paranormal explanation and for a time it seemed blocked bowels were the answer and from there it was a short segue into a full attack on the body, with diets to cool the blood, mixed with vomiting and purging, and when that didn’t work patients were chained up and the madness beaten out of them.
Even so it was hard to know what to do with the mad. Families were generally burdened with caring for the afflicted and sought relief in herbal remedies or visits to shrines. There were folk myths about mad people being put on to rafts and boats and having to fend for themselves. For a modern historian such as Michel Foucault this legend of the ship of fools being ‘‘quite a common sight’’ was the main conceit of his foolish and hugely influential 1964 book Madness and Civilization.
One of the most important developments was the asylum, especially the example of Bethlehem Hospital in the late 14th century. The name was shortened to Bedlam and quickly became the byword for the horrors of the asylum. It was so well known by the time of Elizabeth that Thomas Middleton had scenes set in it to thrill and repulse his audiences. Madness was a theme that intrigued most Elizabethan playwrights, especially Shakespeare, who seemed to be obsessed by it, as have many writers since.
The image of the chained and thrashed mental patient haunted the English and by the 19th century asylums were built at public expense. This utopian ideal was founded on the notion of the asylum being a humane and caring environment where those who could not cope with the world found respite. But no matter how many asylums were constructed, more lunatics materialised to fill them, and soon there was overcrowding, barely contained violence and daily chaos, all of it overseen by poorly trained attendants.
Scull is excellent on how medical men tried not only to define madness but to cure it, and it’s at this point in history when the treatment of the insane began to resemble outright torture. One remedy was pouring water down the victim’s throat until the patient almost drowned. In the US marriage of the mentally unfit was forbidden and in Germany in the 1930s between 300,000 to 400,000 were compulsorily sterilised or killed.
It’s not as if theories of madness were any closer to a cure. Freud’s idea of making the unconscious desires and drives conscious through a talking cure based on memories of sexual repressions, slips of the tongues, analysis of dreams and the power of free association was nothing more than pseudoscience. The fluid definition of what constituted madness resulted in psychiatrists deciding that gays were mentally ill.
Then came the monstrous figure of ‘‘Mom’’, who was blamed for creating schizophrenics and autistic children. Not content with that, recent psychiatrists such as RD Laing and Jacques Lacan wove crazy theories that may not have helped their patients but appealed to academics.
You would think that as the 20th century went on doctors would be more enlightened in dealing with the mad, but this is where Scull’s
One Flew Over the Cuckoo’s Nest book becomes truly frightening. Electroconvulsive therapies became a quick-fix cure, as were lobotomies where the frontal loses were sliced off with an ice pick driven into the patient’s brain via the orbit over the eye. Scull tries to remain neutral throughout his history but even he has to conclude that the chief perpetrator of this treatment, American physician Walter Freeman, was ‘‘nothing less than a moral monster’’.
During the past 30 years asylums have been emptied and closed due to two main reasons: they are very expensive to maintain and new drugs mean insanity can be controlled. The pharmaceutical industries adore this because the patients have to keep taking their pills — antipsychotics and antidepressants rank among the most profitable of all drugs today. The downside of returning the mad to the community is there for anyone who lives in the inner city to see — the homeless, loony and abandoned living among criminals, addicts and the poor.
Scull’s enlightening and comprehensive book brilliantly interweaves medical and cultural history, and the many illustrations are vivid examples of how we’ve viewed madness through the ages. There are some real villains and well-meaning clods in the book, but it’s Australian psychiatrist John Cade who emerges as somewhat of a hero. His discovery of lithium has helped many a mentally ill person to achieve an inner calmness and, as such, he should be more well-known here.
Louise Fletcher and Jack Nicholson in the 1975 film