Revolutions in the head
Has high praise for a survey of how ‘the mad’ have been regarded by society across thousands of years
JONATHAN ANDREWS Madness in Civilization: A Cultural History of Insanity by Andrew Scull To provide a comprehensive narrative of the cultural history of insanity across western and eastern civilisations over more than two millennia in a single volume of under 500 pages would be a daunting task for anyone. That Andrew Scull has achieved this ambitious goal so adeptly is testament to the depth and breadth of his erudition after four decades at the scholarly vanguard of psychiatric history, and to his intellectual dexterity as a writer. It is also a reflection of how far research in this field has come since Michel Foucault’s 1961 Folie et Déraison, repackaged in 1964 as Madness and Civilisation – a phrase Scull provocatively revises in his title. As beautifully illustrated as it is written, Scull’s book is so engaging because he is a superb storyteller with an unfailing appreciation for apposite piquant quotation. His racy, thought-provoking prose aids its readability for both an academic and general readership.
Inevitably, because of the study’s dizzying scope, enormous discernment in choosing topics is needed. Scull rarely disappoints in this regard, guiding us pacily but adroitly on an HG Wells-like time machine from madness in Greco-Roman antiquity, early Christian, Byzantine and Islamic civilisations, through supernatural conceptualisations to the stigmatisation of early modern madhouses and asylums of the 19th and 20th centuries, concluding with a characteristically sceptical account of modern ‘psychiatric revolutions’ and the ambiguous impact of post-1950s psychopharmacology, neuroscience and community care.
Particularly captivating and distressing in equal measure is Scull’s survey of the false dawns and ill consequences of “desperate (physical) remedies”, from malarial treatment and ECT to neurosurgery, as well as the varied cultural and institutional influences of Freudian and post-Freudian psychoanalysis. As a cultural history Scull’s text necessarily traverses a wide terrain, including the place of madness in art, drama, prose, poetry and music, sometimes requiring virtuoso leaps of topic.
At times there is an almost voyeuristic cynicism in the way Scull excavates the tragic misconceptions of mad-doctors, psychoanalysts, neurosurgeons and psychiatrists. The constant saving graces of Scull’s approach are its compassionate, humanitarian concerns, and its foregrounding of the consequences of the psychiatric innovations he charts. Some might question the rather limited attention Scull gives to the testimony of mentally ill people themselves, but this would be to underestimate his achievement in addressing so enthrallingly what madness has meant for societies past and present, and the complex responses it has evoked.
This is a milestone text in its genre. No other monograph has accomplished such scope, perception and balance in covering madness’s haunting, shifting
presence in civilisation’s psyche.