Miller on Pietikainen, 'Madness: A History'

Petteri Pietikainen
Ian Miller

Petteri Pietikainen. Madness: A History. New York: Routledge, 2015. 354 pp. $150.00 (cloth), ISBN 978-0-415-71316-0; $49.95 (paper), ISBN 978-0-415-71318-4.

Reviewed by Ian Miller (University of Ulster) Published on H-Disability (May, 2017) Commissioned by Iain C. Hutchison

In Madness: A History, Petteri Pietikainen provides the first monograph-length study of the history of mental illness from antiquity to the present since Edward Shorter published his extensive A History of Psychiatry back in 1997. Madness differs from Shorter’s work, Pietikainen suggests, as the author is more willing to consider mental illness history beyond the environmental determinist perspectives of biological psychiatry. Instead, Pietikainen seeks to draw from a richer methodology base and pay closer attention to patient narratives and experiences (Shorter was quite wary of sociological models that threatened to reduce mental illness to a “myth” or social construct).

An up-to-date textbook on mental illness is certainly welcome, particularly one that incorporates the ever-expanding amount of research and publications on mental health history. A key strength of Madness is its synthesis of decades of increasingly detailed and nuanced research. When Shorter published his book, the history of psychiatry was still very much tackling the implications of structuralist accounts, such as Elaine Showalter’s The Female Malady (1985) and Andrew Scull’s Museums of Madness (1979). These connected the social and economic histories of (Western) madness to feminist and neo-Marxist agendas respectively. Pietikainen’s Madness demonstrates the more diverse ways in which mental health history is now reflected upon. He concedes that mental illness cannot be reduced to a social fabrication to be erased by tackling negative social structures, values, and norms, and argues that mental disorder is also influenced by changes and problems in human biology—what Pietikainen considers to be the “reality” of mental disorder.

This approach mostly works. Pietikainen commences Madness by examining mental illness up to the Enlightenment, offering insight into the major epistemological shifts in understanding mental disorder in this period. While acknowledging the need to consider the biological reality of mental problems, at times, I remain a little unconvinced by the occasional integration of distinctively twenty-first-century approaches to understanding past maladies. For instance, in his examination of eighteenth-century “dancing mania” (a European-wide phenomenon in which relentless dancing, often to the point of exhaustion and death, spread in a contagious fashion), Pietikainen argues that the problem was most likely a “collective stress reaction” of the lower social classes to physical and spiritual anguish and despair caused by famine, diseases, and poor harvests (p. 43). This may well have been the case, but transposing twentieth- and twenty-first-century diagnostic categories onto past conditions is a precarious approach and one that, at times in this book, can distract a little from an otherwise thorough, thought-provoking, and clearly written synthesis of a vast subject.

Pietikainen is at his best when assessing the values and approaches of past societies and demonstrates a keen eye for areas of critical interest to scholars and students: possession, exorcism, witchcraft. The emphasis here, for the most part, is on Western medicine. Not that this is necessarily a bad thing; to attempt to cover the entire world in full depth would have diluted the fine layers of detail that Pietikainen provides. Pietikainen occasionally provides fascinating glimpses into mental health-care systems in contexts such as medieval Islamic medicine and, later, Argentina during the military junta of the 1970s and 1980s, which add richness, rather than distraction, to his story.

Madness continues by examining the nineteenth-century rise of the “lunatic asylum” and the transformation of mental disorder into a medical condition to be cured by trained specialists (or “alienists”) in an institution. Pietikainen maintains his integrative approach by assessing the psychiatrists who treated patients, their diagnostic and therapeutic arsenal, and, where possible, the perspectives of patients themselves. Considerable space is given to the changing nature of mental diagnosis over time internationally.

Asylums are a well-trodden area. Indeed, medical historians seem to never tire of examining asylums. Nonetheless, Pietikainen draws together a rich literature in a clear, accessible manner. Surprisingly little attention is given to gender, an omission all the more noticeable given the centrality of debates between Showalter and other scholars, including Joan Busfield, not to mention the implications of conditions such as shell shock for expert and public thought on the gendering of mental disorder. Pietkainen is perhaps correct to avoid the excesses of feminist prescriptiveness inherent in some earlier research in this area, but those scholars were justified in pointing out significant gendered dimensions of mental health care which was replete with very “real” ideas, discourses, and practices with implications (often negative ones) for female patients. Similarly missing is sustained discussion of the impact of psychiatric practices on other marginalized groups, most notably homosexuals and immigrants. While it would be wrong to pick out inevitable omissions in a textbook with space limitations, these do seem to be areas of critical importance that help us better understand the nature of psychiatric thought and practice, its capturing of sexual and “moral” behavior, and the persistent impact of subjective sociocultural ideas on problematic implications for patients.

Madness closes with a detailed discussion of twentieth-century activities in mental health: the rise of problematic technologies (e.g., electroconvulsive therapy, coma therapy), de-carceration, and the pharmacological revolution. In many ways, this is the strongest section of the book. Perhaps due to a (comparative) lack of secondary material in these areas, Pietkainen relies more extensively on his own readings of primary texts and analyzes patient experiences more extensively than in other sections of the book.

Overall, Pietikainen’s Madness is a useful addition to mental health history. Its strengths rest in its impressive synthesis of a voluminous, ever-expanding historiography that covers the subject from antiquity to the present from an international perspective. Pietikainen adopts a big-picture approach that skillfully draws from a plethora of micro-histories and local studies to form opinion on the historical role of psychiatry and the nature of mental illness itself. Madness will prove of interest to scholars and students alike. 

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Citation: Ian Miller. Review of Pietikainen, Petteri, Madness: A History. H-Disability, H-Net Reviews. May, 2017. URL:

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