Andrew Scull

Social order/mental disorder : Anglo-American psychiatry in historical perspective

1. Introduction - Reflections on the Historical Sociology of Psychiatry 2. Humanitarianism or Control? Some Observations on the Historiography of Anglo-American Psychiatry 3. The Domestication of Madness 4. Moral Treatment Reconsidered 5. The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic 6. From Madness to Mental Illness: Medical Men as Moral Entrepreneurs 7. John Conolly: A Victorian Psychiatric Career 8. A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum 9. Was Insanity Increasing? 10. Progressive Dreams, Progressive Nightmares: Social Control in Twentieth Century America 11. Sex and Madness 12. Cyclical Trends in Psychiatric Practice: The Case of Bettleheim and Tuke 13. The Theory and Practice of Civil Commitment 14. The Asylum as Community or the Community as Asylum: Paradoxes and Contradictions of Mental Health Care

From Madness to Mental Illness: Medical men as moral entrepreneurs

This paper seeks to provide a sociological account of one aspect of a highly significant redefinition of the moral boundaries of English society: a redefinition which saw the transformation of insanity from a vague, culturally defined phenomenon afflicting an unknown, but probably small, portion of the total population into a condition which could only be authoritatively diagnosed, certified, and dealt with by a group of legally recognized experts and which was now seen as one of the major forms of deviance in English society. Where in the eighteenth century only the most violent and destructive amongst those now labelled insane would have been segregated and confined apart from the rest of the community, by the mid-nineteenth century, with the achievement of lunacy ‘reform’, the asylum was endorsed as the sole officially approved response to the problems posed by all forms of mental illness. In what follows, I want to focus attention rather closely on one centrally important feature of this whole process—and that is just how that segment of the medical profession which we now call psychiatry captured control over insanity; or, to put it another way, how those known in the early nineteenth century as mad-doctors first acquired a monopolistic power to define and treat lunatics. I shall begin, though, with some general remarks on the sociological importance of the issues I shall be raising here.

A New Trade in Lunacy: The Recommodification of the Mental Patient

consigned swiftly enough to the dustbin of history. The widespread acceptance accorded to Erving Goffman’s (1961) chillingly explicit equation of the mental hospital and the concentration camp accurately reflects, I think, the depths to which the asylum’s reputation has sunk. In the circumstances, it is perhaps unsurprising that recent shifts in social provision for the chronically crazy should have been greeted initially with such general and unqualified enthusiasm. After all, the fundamental thrust of the new policies has been toward deinstitutionalization-the deemphasis, if not elimination, of the state-run dumps in which long-stay patients have traditionally been housed. And according

Somatic treatments and the historiography of psychiatry.

The physical therapies have emphasized the essential unity of mind and body. The fact that mental illnesses are in a degree amenable to procedures easily comprehended by all as ’treatment’ goes far to establish the attitude that these are really illnesses like all others, and not incomprehensible reactions which split the victim away from the rest of mankind and from ordinary concepts of sickness and treatment.

Psychiatry and social control in the nineteenth and twentieth centuries

Over the course of the first half of the nineteenth century, in England,’ in Continental Europe,2 and in North America,3 the typical response to the deranged underwent dramatic and radical changes. The metamorphosis occurred at the level of both ideas and social practices; and it made irrevocable the differentiation of the insane from the wider category of the merely indigent and troublesome. In a highly significant redefinition of the moral boundaries of Western society, insanity was transformed from a vague, culturally defined phenomenon afflicating an unknown, but probably small proportion of the population into a condition which could only be authoritatively diagnosed, certified, and treated by a group of legally recognised experts. Whereas in the eighteenth century only the most violent and destructive amongst those now labelled insane would have been segregated and confined apart from the rest of the community, with the achievement of what was widely portrayed as a major social reform, the asylum was endorsed as the sole officially approved response to the problem posed by mental illness. And, in the process, the boundaries of who was to be classified as mad, and thus was to be liable to incarceration, were themselves transformed. The crystallization of this new ensemble of social practices and meanings; their striking and sinister embodiment in new physical forms that constitute

Desperate remedies: a gothic tale of madness and modern medicine

The theory that many diseases were produced by focal infection or chronic sepsis enjoyed a brief vogue in general medicine in the first quarter of the twentieth century. This paper explores its practical applications in psychiatry, which extended well into the 1930s. The analysis focuses particularly closely on the activities of Henry A. Cotton at the Trenton State Hospital in New Jersey.

Deinstitutionalization and public policy

Deinstitutionalization, originally hailed as a major advance in public policy towards mental illness, has recently become increasingly controversial. This paper reviews the implementation of this policy in the United States, providing a critical examination of some of the central issues and problems that are the focus of current debates. It concludes with a pessimistic assessment of the likelihood of substantial improvements occurring in the lot of the chronic mental patient in the contemporary United States.

Psychiatry and its historians.

Until the last two decades, psychiatric history was written primarily by amateurs, and a peculiar group of amateurs at that psychiatrists themselves. Occasionally, as in the case of Ida MacAlpine and Richard Hunter, 1 the extraordinarily prolific and erudite mother/son team, and in William ParryJones’s definitive history of private English madhouses,2 this situation has produced work that, notwithstanding its elements of partiality, has been of lasting value and significance. In the more usual case, however, the resulting distortions have seriously compromised the scholarly usefulness of the accounts offered creating versions of the past that serve (in ways generally obscured from their authors) to legitimate the profession’s present-day activities; or that represent a harmless form of antiquarianism but largely fail to satisfy the elementary canons of good historiography.3 3

The mental health sector and the social sciences in post-World War II USA. Part 1: Total war and its aftermath

This paper examines the impact of World War II and its aftermath on the mental health sector, and traces the resulting transformations in US psychiatry and psychology. Focusing on the years between 1940 and 1970, it analyses the growing federal role in funding training and research in the mental health sector, the dominance of psychoanalysis within psychiatry in these years, and the parallel changes that occurred in both academic and clinical psychology.

The domestication of madness.

ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7