Mad­ness took hor­ren­dous toll

The Weekend Australian - Review - - Books -

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

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