COMMENTARY

A History of Treating 'Madness'

Andrew Scull, PhD

Disclosures

June 02, 2015

In This Article

Treating Insanity: A Background

As a sociologist and historian who has spent his career trying to understand social, cultural, and medical responses to madness, it has not escaped my notice that one of the most central features of mental illness is usually stigma—stigma that attaches not just to those suffering from its depredations, but also to their families, to the professionals who claim jurisdiction over its treatment, and perhaps, even in some degree, to those who write its history. As psychiatrists know, their competence and claims to expertise are frequently mocked, their interventions denounced, and their motives impugned. Patients have often been their fiercest critics.

Indeed, the mad (or some of them) were vocal critics of their doctors long before there was such a thing as psychiatry—an organized profession that went by that name. Psychiatry as a term of art only came into broad usage in the English-speaking world a century or so ago. Before the early 20th century, those purporting to minister to minds diseased called themselves (or were referred to by others) as asylum superintendents, medical psychologists, or alienists. And earlier still, in the 18th and through the first part of the 19th century, the term of art was mad-doctor, a label that nicely captures the ambivalence with which society at large always seems to regard those who lay claim to expertise in the treatment of the mentally ill. Nor has psychiatry generally enjoyed a particularly happy relationship with its medical brethren, who have at times treated the specialty as an embarrassment. Yet the problems psychiatry wrestles with often represent major challenges to the social order and to the common-sense reality most of us like to assume we share. What can we make of recent developments in the field? And what perspectives might a historian offer about them?

For a quarter century and more after the end of the war against Hitler and Hirohito, American psychiatry was dominated by psychoanalysis. Freudian ideas had immense attractions for the intelligentsia, but they also entered popular culture through their influence on Hollywood and on childrearing practices, influenced as those almost universally were by the writings of Benjamin Spock. Although psychoanalysis had its charms (even for humanistically oriented physicians), it did not have a very good track record when it came to treating severe forms of psychosis—if its sterner critics were to be believed, not much of a therapeutic track record at all. Mainstream medics often viewed its emphasis on the sexual etiology of madness with bemusement if not hostility, and could make little or no sense of the claim that illness could be cured by talk. And psychiatry seemed incapable of reliably distinguishing the mad from the sane, a state of affairs that became an acute embarrassment with the publication of an (in)famous article in Science by a Stanford social psychologist David Rosenhan,[1] which appeared to show how easily psychiatrists could be duped by pseudo-patients, whom the article casually consigned to the ranks of the schizophrenic or the manic-depressive.

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