It would be a shame if Andrew Scull’s Madness in Civilization did no more than draw well deserved applause for his authorship and historical expertise, and a prominent place in the bibliography of madness. In immediate response to Philip Thomas’ MiA review of it, Slaying_the_Dragon_of_Psychiatry commented; “It is true that the questions ‘What should we do to the mad?’ or ‘What should we do with the mad?’ miss the point, but unfortunately the conclusion of this article also misses the point. Before we do any compassionate empathizing, we need to ask the question “What is madness”? More specifically, we need to ask the question ‘What is mental illness?’” (April 13th 2015). Twenty four hours later they added “It looks like I need to answer my own questions.”
My own copy of Madness in Civilization arrived last week, and it is great; comprehensive, brilliantly written, lots of colourful and many disturbing illustrations. Madness’ continuing story, “From the Bible to Freud, from the Madhouse to Modern Medicine” is told as never before, but there seems to be something missing, or at least I haven’t found it yet. I have looked through several of the reviews which have appeared in mainstream press; The Independent, The Financial Times, The Wall Street Journal, The Sunday Times and The Paris Review. Barely a systematic review of the literature but perhaps an indicator of what a wider readership is likely to be interested in and quite possibly take away from a reading. All these vox pop reviews majored upon Scull’s vivid descriptions of how madness has been conceived and responded to through the millennia; the brutality and, in retrospect, the injustice of “treatments” and regimes of “care.” In several cases there was resonance with his oblique but inescapable commentary upon contemporary medical approaches, as no more “scientific,” effective or compassionate than their predecessors. They were, however, no more successful than Philip Thomas in finding answers to Slaying_the_Dragon_of _Psychiatry’s questions.
I have the good fortune to be interested in this area because I have found it a rewarding and fulfilling way of earning a living. I haven’t suffered the pain and distress of being one with “mental illness” that I see in so many that come to me seeking help, meet at conferences or read about in pages such as MIA but it is not difficult to understand Slaying_the_Dragon_of _Psychiatry’s frustration. How can we better understand what we are dealing with here, and how might Andrew Scull’s recent contribution help with that?
To my mind what Scull has done particularly well is illustrate how madness has been with/in/alongside civilisation for at least as long as we can see as we look back into earlier times, but grasping what it is has been elusive, only ever partial, often clumsy, and frequently oppressive towards those identified with it. Although he takes trouble to distance himself from Foucault, the story he tells is also one of ways in which successive idioms have incorporated madness into their world view as a way of identifying what is and what is not “civilisation.”
Whether, as one might discern from a reading of Madness and Civilisation, the latter needs the former as an identifying boundary is the subject of another discussion. It could be one that develops Slaying_the_Dragon_of_Psychiatry’s question, and possibly helps to explain why madness has so readily provoked such intense and frequently brutal reactions down the years. What is timely, and in response to the wide acclaim Madness in Civilisation is enjoying, might be to focus a little more upon what this publication means for us, now. Whatever unpleasant experiences Slaying_the_Dragon may have suffered in their career as a mental health service user, these are unlikely to have been real medieval priests casting out demons, the physically harsh environment of an eighteenth century madhouse or a trans-orbital prefrontal leucotomy performed by Walter Freeman.
That is not to say experiences they may have suffered were not and could still be unpleasant, disabling and experienced as oppressive. Slaying_the_Dragon’s comments, along with many others from people with experience of contemporary mental health services emphasise how often “modern” mental health services do no better than their historical counterparts. Scull has captured this well and the fact that he has been able to present it to a wide audience should be a game-changer. He reminds us it is misleading to argue that contemporary psychiatrists, other mental health practitioners, brain scientists and policy makers all have a good handle on madness, can deal with or provide for it and solve the problems it represents any better than their predecessors.
A century of medical psychiatry has achieved very little. Instead of being institutionalised, mad people are medicated in ways those giving the medicines don’t fully understand and with longer term consequences we have yet to find out about, their unconventional behaviours and experiences are invalidated in favour of conventional expectations and rather than being understood as who they are, they are “treated” into conformity. It may be that the relationship between madness and civilisation is such that some of this is inescapable, but if that is the case then don’t we owe a little more honesty to ourselves and those “civilisation” cannot accommodate? That might provide Slaying_the_Dragon_of_Psychiatry with something of an answer, even if it isn’t a fully welcome one.
Psychiatry Reconsidered is due to be published on May 27th. In it I have had a long hard look at the medical approach to madness, and why it really doesn’t work. Perhaps it is only through understanding why it has been attractive and yet still isn’t satisfactory that we can better understand what we are dealing with, and come closer to answering Slaying_the_Dragon_of_Psychiatry’s challenging questions.