Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine, by Andrew Scull

Staff review by Chris Saliba

An exhaustively researched history of mental illness and its many dubious treatments.

Andrew Scull is Distinguished Professor of Sociology and Science Studies at the University of California. He is also an esteemed historian of psychiatry. Madness in Civilization is a comprehensive history of madness, from the Bible right up to modern times.

Throughout history there has been a struggle to find the source of a person's mental illness. Was it biological, or did madness emanate purely from the mind? For a long time, it was considered that madness was God's curse.

When families discovered they had someone who was mentally disturbed in their family, it was up to them to look after the person. Asylums were later created to look after these people, but they were really little better than prisons. Plenty of abuses took place in these institutions. The most shocking parts of Madness in Civilization deal with 20th century approaches to treating mental illness. The Nazis, with the backing of eminent psychiatrists, simply gassed their mentally ill. American psychiatrists and doctors pioneered the terrible practice of lobotomies. No one really had a clue what they were doing when performing these surgeries. Not wanting to render their patients into a completely vegetative state, it was deemed wise to keep patients conscious while operating. The patient would be asked questions during surgery, to make sure the surgeon didn't sever too much of the brain tissue. One patient, when asked what he was feeling during a lobotomy, said "a knife through my brain".  

Perhaps the most alarming finding of Scull's book is that, despite thousands of years of inquiry into  mental illness, the human race is not much wiser in 2016 than it was in biblical times. The best we can do to alleviate the suffering of madness is through drugs, although this sort of treatment is very far from being satisfactory. In fact, there is a dark underside: the pharmaceutical industry is now tightly wound up with the psychiatric profession. Madness is good for business.

Psychiatrists get a bad wrap in Madness in Civilization. According to Scull, the industry reference book for diagnosing mental illnesses, The Diagnostic and Statistical Manual for Mental Disorders (DSM), is a highly dubious tool. It promotes simplistic, cookie cutter diagnosis that avoids nuance and exploring issues in a deeper fashion with the patient. Psychiatrists, Scull claims, are lacking in empathy due to their reliance on the DSM.

Madness in Civilization is a fascinating yet disturbing read. Disturbing, because so much outright evil has been visited on the mentally ill by civilization. In many ways the doctors and psychiatrists, performing bizarre brain operations and other medical experiments, are the mad ones.

Brilliantly researched and written with considerable authority, this is a sympathetic and thought provoking history. Highly recommended!

Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine, by Andrew Scull. Published by Thames and Hudson. ISBN: 9780500292549 RRP: $45

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