Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine

By Dollar, Ellen Painter | The Christian Century, October 12, 2016 | Go to article overview

Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine


Dollar, Ellen Painter, The Christian Century


Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the

Madhouse to Modern Medicine

By Andrew Scull

Princeton University Press,

432 pp., $39.50

Madness: American Protestant Responses to Mental Illness

By Heather H. Vacek

Baylor University Press, 283 pp., $39.95

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As someone with a bone disorder leading to injury, surgery, and disability, I'm intimately acquainted with what Susan Sontag called "the kingdom of the sick." When I meet fellow citizens of that kingdom--other people with my disorder or a friend with rheumatoid arthritis--our common experiences forge an immediate connection.

The kingdom of the mentally ill has some terrain in common with the kingdom of the sick. I have friends, for example, with whom I share the burden of taking daily medication--for them an antidepressant, for me opioid pain relief. In both cases it's necessary for daily functioning and also widely stigmatized in a culture that likes to believe that with the right all-natural diet or physical practices we can avoid Big Pharma's wily clutches.

But the kingdom of the mentally ill lies in a poorly mapped corner, a foreign landscape I struggle to understand. I have a childhood friend who has cycled in and out of psychiatric hospitals for more than two decades. Every few months she starts calling, sometimes several times a day, to tell me what simple thing she needs (money, a place to stay, a job, a lawyer, her ex-boyfriend's love). I can relate to a condition that leads to loss of control, stigma, isolation, and pain. But I struggle to relate to a condition that alters someone's reality so deeply that she doesn't perceive herself as sick.

There's a similar disconnect between the history of physical illness and that of mental illness. Siddhartha Mukherjee's award-winning narratives, The Emperor of All Maladies: A Biography of Cancer and The Gene, have a clear momentum. Early efforts to understand cancer or genetics may have fumbled; mistaken notions may even have held sway for decades. But over time, understanding increased in measurable ways and led to real advances in knowledge and treatment.

The history of mental illness, in contrast, reveals repeated cycles more than a linear movement. Understandings of mental illness as rooted in the body and/or brain give way to understandings of mental illness as rooted in psychosocial circumstance, and then revert. Mentally ill people have benefited from more effective medications, the shutting down of institutions where inhumane conditions and barbaric treatments were commonplace, and greater awareness of how frequently conditions such as depression affect our neighbors. But we're also struggling to find therapeutic options for people discharged from institutions without adequate community care in place, constrained by a medical system that favors cheap medication over therapy, and stymied by rising rates of disorders such as autism. These dilemmas are at least partially rooted in the fact that it's not clear what causes mental illness--measurable bodily processes, life circumstances, or both.

Andrew Scull, who teaches sociology and science studies at the University of California, San Diego, presents a comprehensive history of mental illness in his hefty but engaging volume. Scull demonstrates how early traditions, including Hippocratic, Galenic, Islamic, and traditional Chinese medicine, located insanity at least partly in the body. Many of these traditions were also surprisingly holistic, recognizing a social component of mental illness for both the afflicted and their families. Moving on from the ancient world, Scull takes readers on a brisk but thorough tour of the next centuries, from the medieval preoccupation with sin as the fundamental cause of all illness to the

first hospitals (which were meant more for travelers, orphans, and the destitute than for sick people). …

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