Back to Bedlam: Patrick Skene Catling on the book that makes madness visible

It turns out that mental illness isn’t a new invention. Andrew Scull’s Madness in Civilization reviewed

4 April 2015

9:00 AM

4 April 2015

9:00 AM

Madness in Civilization: A Cultural History of Insanity Andrew Scull

Thames & Hudson, pp.448, £28, ISBN: 9780500252123

Madness is an ancient, evidently inscrutable mystery, often regarded with superstitious fear, yet can provide a refuge from reality. Sometimes, however, the refuge turns out to be a trap. The human brain, beyond even the most rigorous thinker’s continuous control, is equally able to afford exquisite privacy and atrocious chaos.

Andrew Scull, born in Scotland and educated at Oxford and Princeton, a Distinguished Professor of Sociology and Science Studies at the University of California, San Diego, and the author of psychiatric books highly esteemed by medical historians on both sides of the Atlantic, has now written a learned, liberally humanitarian and wryly witty account of how people in civilised societies have tried for more than 2,000 years to limit the amount of harm done by mental abnormality. He writes with such admirable verve and lucidity that it is sad to note that his thesis is gloomy. He comprehensively demonstrates that nobody has ever been able to achieve anything better than keeping madness locked away out of sight or, at best in public view, suppressing its symptoms.

At the outset of this complexly suggestive, profusely illustrated work, Scull promises to consider madness medically and in its social and cultural ramifications. Madness, he observes, remains

a source of recurrent fascination for writers and artists and their audiences. Novels, biographies, autobiographies, plays, films, paintings, sculpture — in all these realms and more, Unreason continues to haunt the imagination and to surface in powerful and unpredictable ways.

The book abounds in references to literature and other arts, none more aptly than Dryden’s couplet, ‘Great wits are sure to madness near allied/And thin partitions do their bounds divide.’

Writers who entertainingly illuminate Scull’s text include Shakespeare, whose Titus Andronicus of all his tragedies is the most pathologically frenzied, Cervantes, whose hero Don Quixote attains sanity only as he is dying, and Henry Mackenzie, an 18th-century novelist whom Scull calls an exploiter of a ‘mawkish but lucrative sector of the literary marketplace’, whose bestseller The Man of Feeling describes a visit to Bedlam. Voyeurs used to pay the keeper of the asylum for the privilege of mocking the inmates, although the sights and sounds of the spectacle, in Mackenzie’s words, ‘the clanking of chains, the wildness of their cries, and the imprecations which some of them uttered formed a scene inexpressibly shocking’. Readers might be reminded of other writers and artists closer to our own times who seem to have been inspired by various psychotic disturbances, such as James Thurber by Mittyesque reveries of relief from his nagging wife, Evelyn Waugh by the paranoiac hallucinations of his alter ego, Gilbert Pinfold, Dalí by distortions of time, and Francis Bacon by alcohol and sexual hysteria. Scull says he ‘seeks to give psychological medicine its due, but no more than its due’, and stresses ‘how far we remain from any adequate understanding of the roots of madness, let alone from effective responses to the miseries it entails’.

There are so many different apparent causes of madness that rival theorists have not agreed whether the prime source is in the body or the mind. Scull surveys the failures to deal effectively with the disease from Ancient Greece to the present. At the time of Hippocrates the Greeks believed physical and mental ailments were caused by imbalances of the four essential bodily humours: blood, choler, melancholy and phlegm — an explanation as convincing as any concocted afterwards. In the era of the Old Testament, theologians said madness was a divine punishment for sin; and ever since then, in varying degrees, afflicted persons have been made to feel guilty and their families ashamed, or at least embarrassed. Scull recounts in gruesome detail how harshly for centuries the mad have been treated in institutions more like penal colonies than hospitals.

Freud’s excavations of regressive complexes in the subconscious offered solace and established psychoanalysis as a thriving industry. Radical therapeutic interventions by electric shock and brain surgery were worse than useless. The overcrowded publicly funded insane asylums were recently disbanded, mainly for financial reasons, and the inmates were ‘returned to the community’, which sometimes meant commitment to lonely suffering in the streets. Now the pharmacologists have taken over. Tranquillising and antidepressant drugs are addictive and expensive, but they help users not to think.

Madness is inseparable from civilisation, Scull concludes. In fact, in every civilised country, the pressures of materialistic ambition in a market-driven economy inexorably increase the incidence of nervous collapse. The ways civilisation is deteriorating, Winston Smith will always love Big Brother, and one day madness will be normal.

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  • mikewaller

    I find books and reviews like this deeply frustrating because, to my own satisfaction at least, I believe that I have come up with an evolutionary explanation for the persistence of what is here termed “madness” that has meet the academic standard of peer reviewed publication (see “Family stigma, sexual selection and the evolutionary origins of severe depression’s physiological consequences”, Journal of Social, Evolutionary and Cultural Psychology, 2010, 4(2) 94-114) yet for which I can elicit little of no interest.

    Put at its simplest, I have built an argument, solidly grounded in the genetic theory of evolution, which proposes that species like our own which, for the most part, carefully select mates for breeding purposes, are highly likely to have preceded stockbreeders and insurance companies in seeing a prospective mate’s kin as a valuable source of information with regard latent genes within that individual’s genome. The downside of this is that some individuals may have (or come to believe they have) characteristics so injurious to their kin group’s attractiveness as mates, that even if they produce young of their own, their overall contribution to the group’s gene throughput will be negative. In such instances, a profound sense of failure inducing chronic depression with that having the potentially lethal physiological consequences that modern science now recognises that it does have, would make perfect sense in terms of inclusive fitness theory by taking that individual out of the gene pool.

    Having said that, I need to stress that this is not a possibility from which I take any satisfaction. Indeed my own interest in the subject arose from a personal experience in which I took on a job for which I was singularly ill-suited, to escape from which the best course was to present myself as positively as possible in seeking a new employment. Instead, I succumbed to a serious bout of depression. Although my own problems resolved themselves, as I am a firm believer in the maxim “a problem explained is a problem half solved”, I embarked on the intellectual odyssey that, after almost four decades of effort, brought forth the above theory.

    As the reviewer points out “the pressures of materialistic ambition in a market-driven economy inexorably increase the incidence of nervous collapse” because crucially in the terms of my theory, comparative success – the key to a sense of well-being – is so intensely fought over. Sadly, at present I am struggling to find a platform of any kind from which to put forward these ideas. So should anybody out there be interested, get in touch.