Campbell on Scull, 'Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine'

Andrew Scull
Morag Allan Campbell

Andrew Scull. Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton: Princeton University Press, 2015. 448 pp. Illustrations. $39.50 (cloth), ISBN 978-0-691-16615-5; $24.95 (paper), ISBN 978-0-691-17344-3.

Reviewed by Morag Allan Campbell (University of St Andrews) Published on H-Disability (November, 2017) Commissioned by Iain C. Hutchison

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In Madness in Civilization, sociologist and historian Andrew Scull has undoubtedly taken on a formidable task in attempting to trace a cultural history of madness from ancient times to the present day. At the very outset, he defends his use of the word “madness” rather than using “softer,” more euphemistic terminology. Madness, he claims, is a term that most people will readily understand. It has existed throughout the years, not just as an everyday term, but also, at times, one used by medical men. Madness, the lasting disturbance of “reason, intellect and emotions,” is woven into the fabric of civilization, at once fascinating and frightening us, existing in all societies and across all time periods. Dismissing wholly constructionist views as “romantic nonsense,” Scull notes at the outset how far we still are from any real understanding of the causes of mental illness and from its effective treatment, a statement which gives some indication of the content to follow (p. 11).
The book is divided into twelve chapters, taking the reader chronologically from ancient times to the present day. Each chapter forms a distinct section so it is possible to pick up the book at any point and easily grasp a sense of that section as a stand-alone esssay. Careful cross-referencing directs the reader to any area referred to but more fully covered elsewhere in the book. It is nevertheless an inviting prospect to read the book from start to finish; engagingly written and highly accessible, the book makes compulsive reading once started and each chapter invites the reader on to the next. This is no dry text book, and at times, indeed, the text strays into an unexpectedly evocative and literary style--we are left in no doubt, for example, of the “madness” that swept across the world at the start of the twentieth century, of the horrors of trench warfare and the “desperate remedies” employed in order to return traumatized soldiers to the killing fields (p. 290).
The twelve chapters of the book may be considered in three main phases. Having “confronted” madness in a short first chapter, and outlined his aims for the volume, Scull sets out to explore madness in the ancient world, examining perceptions of the divine or preternatural origins of madness in ancient Greece and in Roman mythology, where madness was the ultimate punishment for transgressions against the gods, and possession by demons the underlying cause. He describes the power of saints and their relics in Roman and medieval periods, a time when “madness bore no single meaning and answered to no single approach” (p. 85).
The central phase of the book brings us into the area that is most surely Scull’s home ground: the world of madhouses and mad doctors. By the early eighteenth century, an increasingly market-orientated society armed the better off with the paying power to fund a practical solution to the problem of a mental illness, leading to a rising “trade in lunacy.”[1] Scull traces the rise of private madhouses, suggesting that the new society was led to “calculative attitudes” and a harsher view of how to deal with a lunatic in the family (p. 136). Fashionable diseases and nervous disorders provided work for society physicians. He then progresses on to the Great Confinement, or the “rise of the empire of asylumdom” (p. 190).
In the later chapters, we are confronted with the “mud and blood, blood and mud” of the First World War, and the horrors of twentieth-century psychiatry (p. 291). Sigmund Freud (1856-1939) and the psychoanalysts are dealt with as a more “meaningful interlude,” though Scull notes that, despite popular tendencies to associate the “analytic couch” with the subject, mainstream psychiatry has generally held Freud’s ideas in disdain (pp. 322, 325). 
The book is richly illustrated with both black and white images and color plates. Many of these will be familiar to historians of madness, and the standard images are included--John Everett Millais’s Ophelia (1851-52), Philippe Pinel freeing the lunatics from their chains, the lunatics’ ball, etc.--but there are many less customary offerings that serve as striking accompaniments to the book’s main messages. Shots of transorbital lobotomies and ECT procedures in progress, and even instruments for stunning pigs prior to slaughter, help to underline some of the atrocities of twentieth-century treatments, while the anxious housewife advertising “mother’s little helper,” not to mention “No sex please, we’re on antidepressants,” gives a scarcely more optimistic view of the pharmacological revolution (pp. 382, 400). 
It is worth noting that, on balance, the book takes a western, north Atlantic bias, begging the question of what exactly Scull means by “civilization.” However, it would be unfair to suggest that Scull’s examination is entirely focused on a geographically specific approach, though much of the comparison between East and West is limited to the early chapters.
It is hard to escape Scull’s lack of optimism about recent and current developments and thinking in the field of mental illness. He is outspoken on the subject of de-incarceration, the outcome of which he sees as prisons full of the mentally ill--ironically, the circumstances that prompted eighteenth-century philanthropists to build places of safety and asylum for sufferers, those very institutions society came to despise--and the chronically ill, outcast and despised, living on the streets. This is a development which he claims has brought us “full circle” (p. 378). Equally, while it would be unwise to dismiss the advantages of current drug treatments, we should not “uncritically swallow the equally one-sided and overblown claims of the pharmaceutical industry and its allies in the psychiatric profession” (p. 404). 
This is not a history of psychiatry--the term and indeed the concept are recent innovations--but a history of the ideas and perceptions surrounding insanity. Scull has explored the history of madness through fable and fiction, through the frameworks devised to make sense of the senseless, and in the deeds and actions that have followed in their wake. This is a history of the stories that have been told, and the struggle for understanding. Madness in Civilization is indeed ambitious in its breadth and scope, and inevitably, it will be lacking in detailed study of more specific lines of enquiry. Among his many works, Scull is also the author of Madness: A Very Short Introduction (2011), one of the Oxford University Press's range of introductory guides; in many ways, this big volume expands and elaborates on that little book, yet loses nothing in terms of accessibility. Scull has successfully drawn on his forty years of scholarly research to produce another excellent introduction to the subject which will surely serve as a landmark in the field.
[1]. See, for example, Andrew Scull, Cultural Sociology of Mental Illness (San Diego, CA: University of California Press, 2014).

Citation: Morag Allan Campbell. Review of Scull, Andrew, Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. H-Disability, H-Net Reviews. November, 2017. URL:

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