A History of Anglo-American Psychiatry


It comes as something of a shock to realize that I have been researching and writing about the history of Anglo-American psychiatry for more than forty years now.  It scarcely seems possible that more than three decades have passed since I first begun burrowing around in the archives of those Victorian museums of madness that in the early 1970s were still the all-too-concrete legacy of the enthusiasms of an earlier generation – those warehouses of the unwanted whose distinctive buildings for so long haunted the countryside and provided mute testimony to the emergence of segregative responses to the management of the mad.  I can still vividly recall my first encounter with those structures: the vast and straggling character of the old, already-decaying asylums; and the elegant façades (and the not-so-elegant back stage features) of the bins catering to a more affluent clientele. It is hard to forget the sense of constriction and confinement that oppressed one’s spirit on crossing the threshold of one of these establishments.

At a slightly deeper level, one recalls that there was a frisson of fear playing at the edges of one’s consciousness, an almost daily emotion I then tried to dismiss as irrational, and now recognize was a subterranean anxiety that reflected — not any sense of physical danger from one of the pathetic, drug-addled patients who still haunted the hallways — but the barely suppressed nightmare that one might find oneself trapped permanently in one of these barracks-asylums (whereas, in fact, of course, I was always able to retreat gratefully back into the “real” world once night fell).  Above all, perhaps, I remember the smell; the fetid odor of decaying bodies and minds, of wards impregnated with decades of stale urine and fecal matter, of the slop served up for generations as food, the unsavory mixture clinging like some foul miasma to the physical fabric of the buildings.  Small wonder that the English alienist George Man Burrows once proclaimed that he could unerringly identify a madman by the peculiar odor that emanated from him.

Nowadays, such encounters with the physicality of mass segregation and confinement, with the peculiar moral architecture which the Victorians constructed to exhibit and contain the dissolute and degenerate, are increasingly fugitive and fast-fading from the realm of possibility.  Many of these institutions are crumbling into dust.  Trenton State Hospital, for example, once home to experiments on mental patients that killed hundreds and maimed thousands more, is now largely empty. The once handsome trees that adorn its grounds are tangled, neglected and overgrown.  Their sepulchral shade creates a dank and dismal atmosphere in the abandoned buildings they tower over.  Mold and putrefaction are everywhere.  Iron bars on the windows deposit brown rust stains on to the stone and brick beneath.  An eerie silence and emptiness reigns.  Rotted metal screens encrusted with nameless dirt and filth partially obscure the broken panes of glass beneath, through which the trespassing visitor can peer into empty wards, bereft of furnishings, human and inanimate.  The guardhouse that once kept out the curious is unmanned.  No-one strives any longer to sustain the previously inviolable boundary between the worlds of the mad and the sane.  Such scenes could be replicated all across what calls itself the civilized world.

Other asylums have been transformed into luxury hotels (like Venice’s former asylum for mad women on San Clemente Island) or into luxury condominiums for the well-to-do (like the former Colney Hatch Asylum in London, now re-christened Princess Park Manor, and sold to innocent buyers as “a Victorian masterpiece which has delighted and inspired aficionados of fine architecture for generations”).  With delicious irony, its developers proclaim that once introduced to the delights that await them on site, the new residents will never want to leave.

My first encounters with the sights, the smells, the sense of despair that enveloped these total institutions in earlier times, when their wards were still thronged with patients, ought surely to have been enough to put any sane person off any lingering attachment to research in such settings.  A few months of this should have sent me scurrying off in search of more salubrious subjects and objects with which to concern myself.  After all, as any sociologist worth his or her salt could tell you (and as every psychiatrist ruefully knows), one of the dubious rewards that flows from trading in lunacy is a share in the stigma and marginality we visit on those unfortunate enough to lose their wits. Yet I have resisted the temptation to abandon madmen and their keepers to their fate.  The irrational, and what I am sometimes tempted to think are our culture’s equally irrational responses to craziness, have continued to hold me in thrall.  I remain as intrigued as I was forty years ago by the puzzles that are posed by what we variously call madness, lunacy, insanity, psychosis, and mental illness, and by the elaborate social institutions we have created to manage and dispose of the mad, both before and after the age of asylumdom.

The loss of reason, the sense of alienation from the commonsense world the rest of us imagine we share, the shattering emotional turmoil that seizes hold of some of us and will not let go: these are a part of our shared human experience and of the cultures we inhabit that down through the centuries. Insanity haunts the human imagination.  It reminds us of how tenuous our own hold of reality may sometimes be.  It challenges our sense of the very limits of what it is to be human.

In the contemporary world, the dominant conceptions of madness consign it to the ministrations of medics, and pronounce it a matter of defective brains and biology.  But in all kinds of settings, mental illness resists being corralled in this fashion.  As it has over many centuries, the subject remains a source of recurrent fascination for writers and artists, and for their audiences.  Novels, biographies, autobiographies, plays, films, paintings, sculpture – in all these realms and more, Unreason continues to inspire speculation, to puzzle us, and to surface in powerful and unpredictable ways.  All attempts to contain it, to reduce it to some single essence, seem doomed to disappointment.  Madness endures, serving to frighten and to fascinate, to challenge us to probe its ambiguities and its depredations.  And despite our best efforts, we remain almost as far as ever from any adequate understanding of the roots of Unreason, let alone from effective responses to the miseries it entails.

The complexities of the human encounter with insanity, as revealed over history’s longue durée, are what tempted me to write Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine.  My hope is to persuade others to share my fascination with this vast and varied territory, and to ponder anew its mysteries.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


  1. “Madness endures, serving to frighten and to fascinate, to challenge us to probe its ambiguities and its depredations. And despite our best efforts, we remain almost as far as ever from any adequate understanding of the roots of Unreason, let alone from effective responses to the miseries it entails.”

    After all is said and done, personally, I’ve come to the conclusion that ‘madness’ exists for the purpose of contrast to inner peace, as this would be our goal, would it not? To my mind, at least, this is the goal. ‘Madness’ is a necessary step in personal growth and spiritual evolution. Without it, we haven’t the passage which is vital to awakening to all that has turned out to be illusion, out of unconscious living.

    The problem with psychiatry as we know it is that it vilifies madness–and by doing so, it unwittingly (or not) vilifies the one experiencing this temporary state of ‘madness.’ In turn, the issues become more chaotic, embedded, magnified, and chronic. This should not be, as this is where it becomes an ‘illness,’ which should never come to pass. Madness is a sign of personal growth and clarity trying to happen. Unfortunately, it is not at all treated this way by modern medicine, and it instead, turned into pathology. Terrible.

    Our internal chaos, which I believe we all possess, becomes loud and dominant in our being when it is time to address it, for the purpose of moving forward with greater clarity. That would be normal personal growth. I’d like to see this supported, rather than condemned simply because it is not understood. Fear and ignorance are the culprits here, not the madness.

    Report comment

    • Also, I wouldn’t call it ‘unreason,’ as madness can be quite reasonable, and I’ve often found ‘madness’ to be rooted more in rage from betrayal rather than lack of reason. In fact, to me, with the kind of betrayal we’ve faced in society, from health care, government, etc., I’d say madness is highly reasonable and totally understandable, and the ‘mad’ people I’ve known are often quite logical, were we to attune to them without fear, and with an open heart and mind to the fact that this is suffering due to society’s lack of reasonable response to someone’s needs.

      Report comment

      • That’s what I say as well Alex, but I know lots of people that have experienced so called symptoms of madness but never accessed help presuming their experience to be quite normal. I’ve known so many people like this that I would say most normal people experience symptoms of madness, and this is why ‘schizophrenia’ had to be invented as an illness to underpin psychiatry. Modern psychiatry has since used this extreme and sinister ‘illness’ ideation very effectively to justify their existence.

        Report comment

        • No, the syndrome has been around for quite a while- go to the Book of Mark in the Bible and read the account of the man named Legion, tortured by auditories and living in the local cemetery. As far as that goes, try the Old Testament and the passages where the future King David is trying to break his mercenary contract with Achish, one of the Philistine kings, which he does by impersonating a madman (though his style seems to be impersonating an epileptic).

          Report comment

      • I largely agree, Alex. Peace of mind is a wonderful gift, but going through a drug withdrawal induced psychosis can result in a better understanding of one’s subconscious, or inner self. Which, if nothing else, is interesting makings for a story. But all people should have a right to hope and pray for their dreams to come true.

        Andrew, as to, “And despite our best efforts, we remain almost as far as ever from any adequate understanding of the roots of Unreason, let alone from effective responses to the miseries it entails.”

        I do, personally, know Robert Whitaker’s concerns that the antidepressants (in my case given for smoking cessation, not depression) do indeed result in adverse effects, which do get misdiagnosed as “bipolar” and “schizophrenia.”

        And a child’s dose of Risperdal (.5mg) can actually cause a formerly healthy adult to become psychotic within 2 weeks of being put on that drug. The “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

        Plus, there are quite a few people now writing about drug withdrawal induced super sensitivity manic psychosis.

        So I do think we may be getting closer to an understanding of what causes at least some, if not most, of the psychosis or “Unreason.” But I believe the medical community needs to start admitting to the adverse effects of their drugs at some point. And they need to stop forcing drugs known to cause psychosis onto innocent people.

        Report comment

        • Hi Someone else,
          It is the drugs, that are the main problem. I’d say everyone has a crisis at some stage and most people find their own way out. But you notice psychiatry doesn’t really recognise recovery, and people don’t recover much with psychiatry.

          Report comment

          • Hi Fiachra,

            I agree completely. I also think the psychiatric industry ignoring real life problems, declaring people’s real lives to be “credible fictional” stories, is a big part of the problem, too. How could a doctor expect to actually help a patient, if he or she doesn’t actually bother to listen or “believe” the actual problem? Psychiatry seems to be just one big Ponzi scheme of creating iatrogenic “mental illnesses” with their drugs for profit.

            Report comment

          • Fiachra,

            Robert Whitaker, and others, provided the evidence regarding the largely iatrogenic nature of bipolar. I personally thank them, and God. But the evidence regarding schizophrenia also being an almost completely iatrogenic illness is in my medical research.

            The antipsychotics are known to cause the schizophrenia symptoms via the central symptoms of neuroleptic induced anticholinergic intoxication syndrome. And let’s be real, no doctor could ever validly distinguish between the central symptoms of anticholinergic intoxication syndrome, “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures,” and today’s current definition of schizophrenia.

            Thus, there is no non-iatrogenic validity to any of the so called “mental illnesses,” including “schizophrenia,” at this point in time.

            I hope and pray we can get this reality to the mainstream.

            Report comment

          • Hi Someone else,
            I do agree that the antipsychotics can drive a person mad when they are on them (I was like this). But when they are stopped the person can also go mad as a result of stopping them; and that if a person stays on antipsychotics long enough they can develop “tardive psychosis”(but most consumers die in middle age).

            Report comment

      • Indeed it is, and I totally agree with you both that the meds can easily cause madness, as well as can the withdrawal from them, which seems to happen more often than not, from what I have read. Also my experience, the withdrawal was horrendous and no one around me knew how to support it, and indeed, attempted to pathologize, although by then I was done with all labels like this, so I just kept moving forward with guidance from my new teachers at that time.

        And certainly the ‘wrong’ clinical support can drive us profoundly mad if we are vulnerable, which is normally the case when we see a psychiatrist.

        Still, I think the healing of this would be the same as any madness–take the healing journey and discover new things. We’ve just got to learn to follow our paths, healing past betrayal so we can learn to trust our own truth and inner guidance. To me, that would be the work to do in order to integrate what we are calling ‘madness.’

        As we emerge from any journey of madness taken consciously and with effective support– which is different for everybody what that means and looks like–we have transformed. Psychiatry and meds totally interfere with and undermine this journey, so that we get stuck in madness, so no transformation takes place, the process is stalled, which is so dangerous for people. The appropriate alternative would mean freedom from this maddening stuckness in madness.

        Report comment

  2. I think you have it with the phrase “warehouses of the unwanted.” The worst excesses of the psychiatric system come because somebody doesn’t want “the patient” around in his or her present state. Whether the person is a nuisance (talkative or “uncooperative” old person or child), a relative newly widowed with children, or a genuine threat to someone’s getting on with daily life in peace, the problem is not that the offending person is disturbed, but that they are disturbing.

    That’s what makes the old cartoon funny: “Hey!” says a guy being hauled off in a straitjacket by determined medics. “I’m not crazy!” In his failure to recognize the motives and tolerances of others, however, he has made a really tragic mistake. And the laugh partly comes because we all know that his coming punishment far exceeds his crime of misperception or temporary self-absorption. He has underestimated the evil of his fellow man.

    Report comment

    • anothervoice,

      Don’t forget two other motives doctors have to drug “patients” up – they ship patients off to the psychiatric practitioners to cover up their own incompetence, easily recognized iatrogenesis (like a “bad fix” on a broken bone), and the medical evidence of child abuse (or other sexual assault).

      Basically, it seems any time a patient has a real life problem a doctor doesn’t want to bother dealing with, they get psychiatrically stigmatized and tranquilized. It doesn’t necessarily have to do with a patient’s behavior, just their life circumstances. “Warehouses of the unwanted” real life circumstances.

      Report comment

      • Someone Else:

        Psychiatrists are the second tier of complication. They make it impossible for patients to get out. Once the psychiatrists have waded in with their “illnesses” the circle becomes self-reinforcing. Relatives pretend they weren’t even in at the first. Now they behave as though the psychiatrists were the original motive force of the “treatment.”

        Meanwhile psychiatrists, who know their role and money-source, keep on with the diagnoses and more and more drugs. The one rule of the profession seems to be “never back up.” So psychiatrists insist that there are no serious side-effects to the drugs. Patients learn not to mention side-effects for fear of added “side-effect” drugs. And any damages become the product of patient “fantasy.”

        All in all, the purpose is to keep you in. Relatives appreciate the control, and psychiatrists want the money. If either feels threatened, the patient suffers more because “more drugs” is the mantra throughout.

        Report comment

  3. Gee, Bonnie Burstow, Robert Whitaker, and now Andrew Scull coming out with new books. After reading a great deal of Thomas Szasz, someone I’m sure to return to in the future, I’m wanting to review the works on madness by Michel Foucault to see if I might have missed something. I guess that makes me something of a dinosaur. I’d really like to catch up with you guys, but I don’t know where to begin, and it might take awhile. Anyway, Madness and Civilization (the History of Madness) or, cut to the chase, Madness in Civilization? I’m really conflicted on this one.

    Report comment