From the Literature: In Search of Madness

In Search of Madness ALEX BEAM: Gracefully Insane: The Rise and Fall of America's Premier Menial Hospital. Public Affairs, New York, 2002, 244 pp., $15.00, ISBN 1891620754. ALLAN V. HORWITZ: Creating Mental Illness. University of Chicago Press, Chicago, IL, 2002, 229 pp., $32.50, ISBN 0226353818. ROY PORTER: Madness: A Brief History. Oxford University Press, Oxford, 2002, 218 pp., $22.00, ISBN 0192802666. ROBERT WHITAKER: Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Perseus, Cambridge, MA, 2002, 219 pp., $27.00, ISBN 0738203858. Madness is not measured by anguish. People whose anxiety or depression confines them to the constrained lives of quiet desperation Thoreau hoped to escape at Waiden Pond are not mad. Rather, it is those whose behavior makes a significant wrinkle in the social fabric who, according to the era, signifiers, and reigning paradigms have been called possessed, mad, touched by divine fire, lunatic, neurasthenic, irrational, insane, crazy, daft, emotionally disturbed, nuts, batty, mentally ill, psychotic, differently abled, suffering from: fire in the brain, vapors, spleen, folly, nerves, nervous breakdown, mental disability, or undifferentiated, residual or paranoid schizophrenia. This sampling of the prodigious and ever-growing number of synonyms and increasingly intricate classifications and distinctions, and the massive body of literature on the subject indicate the enduring importance of this construct in our society. In this context, the four texts under consideration here represent only a small sample of recent books that chronicle the history of madness, to fix on one term, and of our society's reaction and interaction with these bothersome misfits. Alex Beam and Robert Whitaker in their social histories of madness, and Allan Horwitz in his historically organized examination of the construction, all agree with Roy Porter's contention in his own social history that in terms of etiology, differentiation of the mad and the sane, differential diagnoses, and (not necessarily corollary to any of the above) treatment, the more things change the more they remain the same. However, our present location may be unique in the particular equilibrium we have reached, a positioning that represents, instead of the more usual dominance of one theoretical school over the others, a negotiated compromise between the competing paradigms on madness that have dominated the discourse since the time of the ancient Greeks. For those Americans who fall somewhere between the top and the bottom of our social and economic pyramid and who are lucky enough to have health insurance, the commencement of behavior extreme enough to be called mad typically calls forth a systemic intervention that in most cases begins with a very brief hospitalization during which the designated patient receives at least two different kinds of behavior-modifying medication and some combination of milieu and dynamic therapy. Usually some sort of meeting including family members or significant others is arranged. Upon release, the patient is provided with a plan that at least theoretically calls for some measure of all of these elements. This smorgasbord of treatments afforded to the insured in our society encompasses both biochemical and dynamic approaches, all tempered with a healthy dose of neglect. Although no compromise pleases everyone, the biochemical solution generates income for the vast pharmaceutical firms that, with other big businesses, run our country, while precise diagnostic categories and short-term hospital stays satisfy the recently implemented demands of managed care. Meanwhile, the retention of dynamic and milieu therapies provides jobs for a large and hierarchically well-distributed section of the population. This plateau should serve as an excellent site from which to chronicle the history of madness. Still, before proceeding further, we must remind ourselves what a tricky thing it has become to write a history of anything at all. …