Madness: A Brief History [ペーパーバック]

It is of great interest that I read about the early 18th century, when so many of the great philosophers impacted the view with which scientists and physicians (and family too) viewed mental illness. Porter emphasizes that the great humanitarian changes made in the care of those mentally ill occurred then...but in spite of obvious success with providing homes and medical care and even jobs to these unfortunates, the fact that this 'care' did not provide a cure and unfortunately, the input of Darwin's idea of 'survival of the fittest' as promoted by his cousin, caused these asylums to deteriorate into the snake pits of the movies. Since genetics is raising some of the same questions and answer given by the eugenists from 1870 to past WWII ... it is paramount that students and medical personnel be trained in this medical history.

Karen Sadler,
Science Education,
University of Pittsburgh

Porter examines the imposition of madness by the gods in Homer. By the time of Hippocrates (around 400 BCE) madness was a medical, not moral or magical, matter. But supernatural explanations for insanity were advanced again, along with the angels and demons sanctioned by the Christian church. Around the Renaissance, the concept arose that madness was a special sort of inspiration. (There remains folk wisdom that geniuses are not at all far removed from the insane.) Families had originally had the responsibility for lunatic progeny, but the surplus wealth of urban areas encouraged families to buy such services. At the beginning of the nineteenth century in England, confined lunatics were largely in private asylums under what was literally called "the trade in lunacy." Optimism that "moral treatment" might cure such cases was disappointed; in the last of the nineteenth century, a pessimism took over, as few were cured and the asylums became clogged with inmates whose needs were severe. Security and sedation were promoted as the numbers grew. Armed with new classifications of different styles of madness, doctors continued to be frustrated by an inability to change much; one German asylum doctor said, "We know a lot and can do little."

With the revolution in pharmaceuticals in the twentieth century, this changed. Patients were able to leave the asylums, and the medicines promised improvement without long stays in the hospital, long bouts of psychoanalysis, or irreversible psychosurgery, as well as promoting psychiatrists as "real doctors." This is a remarkable book, which is able to take a broad historical view; there are far larger tomes on this subject, and indeed on subjects which here necessarily get only a paragraph or so, but the sweep of the coverage is impressive. Porter ends his summary with unnecessary pessimism. It is true that the last century had its share of abuse of the mentally ill (one does not even have to cite the extremes of Nazi and Soviet persecution), and it is also true that there are more psychiatric diagnoses than ever, and more patients classified as fitting them. Even though the history of the rise of psychiatry and the improvements it can bestow may have had more controversy or backsliding than other branches of medicine, it is a simple truth that those suffering from madness now are better off than they were one or three or twenty centuries ago.