Madness: A Brief History

Rating:
Summary: The Long View of Lunacy
Review: Roy Porter died recently at the age of 55, but produced over eighty books on a wide range of subjects, from the Enlightenment to the English treatment of insanity in various historic periods. It would not be surprising if this polymath has other manuscripts awaiting publication, but _Madness: A Brief History_ (Oxford University Press) was his last production before his death. It is a remarkable work especially for its brevity, taking in prehistoric concepts of madness and ranging all the way into current psychiatric controversies in less than 250 clear, well-researched pages. There have been fashions of treatments for the mentally ill, and just a bit of scientific justification for them most recently, but one of the points of his treatise is to show that we aren't any closer to true definitions of madness than Polonius was: to "define true madness,/ What is't but to be nothing else but mad?" His own lack of definition enables this brief overview to take in a great deal of territory.

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.

Rating:
Summary: The Long View of Lunacy
Review: Roy Porter died recently at the age of 55, but produced over eighty books on a wide range of subjects, from the Enlightenment to the English treatment of insanity in various historic periods. It would not be surprising if this polymath has other manuscripts awaiting publication, but _Madness: A Brief History_ (Oxford University Press) was his last production before his death. It is a remarkable work especially for its brevity, taking in prehistoric concepts of madness and ranging all the way into current psychiatric controversies in less than 250 clear, well-researched pages. There have been fashions of treatments for the mentally ill, and just a bit of scientific justification for them most recently, but one of the points of his treatise is to show that we aren't any closer to true definitions of madness than Polonius was: to "define true madness,/ What is't but to be nothing else but mad?" His own lack of definition enables this brief overview to take in a great deal of territory.

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.

Rating:
Summary: Insanity as a social construct over the centuries...
Review: Roy Porter died way too young. His books on medical history are a must-read for those who enjoy learning, and need to know how medical and scientific changes came about. I am one person who really feels that understand medical and social history is the only way that we can avoid the mistakes of the past, and work towards making the future as equitable in treatment and understanding towards those with mental illness as we can.
Porter's book is small and a quick read. He doesn't dash through, but this is not a textbook. Nor does it cover every possible scientific and social input on what 'makes' madness and what different centuries did to deal with those with mental conditions. If the reader is looking for a first look into the history of mental illness, he cannot go wrong with reading this concisely written book. It will not answer all the questions...in fact, it raises more questions. But Porter not only gives enough information and color to this particular problem, he also gives a wonderful bibliography/reference to refer to if the reader wishes to read about any particular time or problem. I did go looking for several of his recommended books, and I have not been disappointed yet.

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

Rating:
Summary: Madness... Such Beauty!
Review: This book was like nothing I have ever read before. The detail that was shown throughout the book really was able to make me see what it might have looked like, sounded like, felt like and sometimes even smelled like being in an asylum. The amount of information that Roy Porter put into this book was amazing. You might have thought he haad been in an asylum himself. I would absolutely recommend this book to anyone.

Rating:
Summary: Roy Porter's succinct historical summary of madness
Review: This is the first book I have ever read by Roy Porter,
but it won't be the last. He is a polished writer and
in this condensed overview of the history of mental
illness, every word is measured and to the point.

I love the illustrations and do wish the book came
in a larger format.

One grave omission, imho, there is not mention of
lithium as one of the great drugs of the century.

Squiggles

Rating:
Summary: Roy Porter's succinct historical summary of madness
Review: This is the first book I have ever read by Roy Porter,
but it won't be the last. He is a polished writer and
in this condensed overview of the history of mental
illness, every word is measured and to the point.

I love the illustrations and do wish the book came
in a larger format.

One grave omission, imho, there is not mention of
lithium as one of the great drugs of the century.

Squiggles