Table Of ContentPraise for Madness in Civilization
‘Andrew Scull’s fluent mastery of the history of madness has long been
established. In this engrossing volume, he gives us the long view of
how reason has understood and treated unreason. Aided by a telling
and sumptuous array of images, he takes us from ancient Greece, early
Christianity and Islam through science, secularization and Freud, to the
brain sciences and pharmacopoeias of the present. It’s a story filled with
good intentions and punctuated by greed. Flashes of wisdom war with
cures that are far madder than patients. Some two thousand years of
journeying and it’s unclear whether the chemical asylum we’ve arrived at
is any better than its bricks and mortar precedent. This is history at its best,
scintillating in its detail and passionate about a subject that concerns us all.’
Lisa Appignanesi, author of Mad, Bad and Sad: A History of Women and the Mind Doctors
from 1800 to the Present and Trials of Passion: Crimes in the Name of Love and Madness
‘A wonderful book, fascinating and beautifully written, with Scull’s usual
verve and erudition. Madness in Civilization explores how ancient and
medieval societies coped with psychosis and shows that, brain imaging
and psychotropic drugs notwithstanding, modern psychiatry has much
to learn from them.’
Sylvia Nasar, author of A Beautiful Mind
‘An engaging, learned and wonderfully thought-provoking history of
human efforts to understand and manage those behaviours we call mad.
An uncommon combination of learning and accessible writing, I would
recommend Scull’s admirable book to anyone interested in this “most
solitary of afflictions”.’
Charles Rosenberg, Professor of the History of Science, Harvard University, author
of Our Present Complaint: American Medicine, Then and Now
‘Andrew Scull is probably our most knowledgeable and certainly most
readable historian of madness. In his new book, the magisterial Madness
in Civilization, he presents a panoramic view of the subject that’s both
clear-eyed and critical. Crisply written, and furnished with a wealth of
cultural and clinical reference, this is a great, tragic story.’
Patrick McGrath, author of Asylum
‘Andrew Scull is the premier historian of psychiatry in the Anglophone
world, and this book triumphantly demonstrates this. Taking a broad
canvas, from antiquity to modernity, Scull dissects what madness
has meant to societies throughout history and throughout the world.
He writes with passion but humour, has a brilliant eye for a pungent
quotation or a telling story, and holds the reader spellbound. This is
a compelling book from a master of his craft.’
William Bynum, Professor Emeritus of the History of Medicine, University College London,
editor of Companion Encyclopedia of the History of Medicine
‘A work of heroic scholarship, an eloquent overview of the changing
theories and treatments of madness from ancient religion, medicine
and myth to contemporary neuroscience and psychopharmacology.
Scull shows not only how writers, artists and composers have taken
madness as a muse, but also how the shifting symbolic forms of
unreason are truly part of its history. Compendious and compassionate.’
Elaine Showalter, Professor Emeritus, Princeton University, author of The Female Malady
‘Dr Scull is one of the pre-eminent historians of psychiatry in the world
today. There is almost no one else who could write a volume of this kind
with the panache he brings to it, the ability to hold both a lay and an
academic readership in thrall at the same time and the sense of balance
and proportion that comes to some with experience but to others not
at all. There is no other volume comparable to this in scope and this is
a once in a generation effort.’
David Healy, Professor of Psychiatry, Bangor University, author of Pharmageddon
‘Madness in Civilization is a brilliant, provocative and hugely entertaining
history of the treatment and mistreatment of the mentally ill. Packed
with bizarre details and disturbing facts, Andrew Scull’s book offers
fresh and compelling insights on the way medicine’s inability to solve
the mystery of madness has both haunted and shaped two thousand
years of culture. Required reading for anyone who has ever gone to
a shrink!’
Dirk Wittenborn, author of Pharmakon
Andrew Scull
MADN ESS
IN CIVILIZATI O N
A Cultural History of Insanity
from the Bible to Freud,
from the Madhouse to Modern Medicine
With 128 illustrations,
44 in colour
For Nancy, and for our grandchildren
born, and yet to be born
Comme quelqu’un pourrait dire de moi que j’ai seulement fait ici un amas
de fleurs étrangères, n’y ayant fourni du mien que le filet à les lier.
[As one might rightly say of me, in this book I have just created
a bouquet of other people’s flowers, providing myself only
the thread that holds them together.]
Montaigne
Text on the front of the jacket: excerpt from pp. 224–26.
Frontispiece:
‘Madness’, from The Anatomy and Philosophy of Expression,
as Connected with the Fine Arts, by Sir Charles Bell (1844).
Published in the United States and Canada in 2015 by Princeton University Press,
41 William Street, Princeton, New Jersey 08540
press.princeton.edu
First published in the United Kingdom in 2015 by Thames & Hudson Ltd,
181A High Holborn, London WC1V 7QX
thamesandhudson.com
Madness in Civilization © 2015 Andrew Scull
Designed by Karolina Prymaka
All Rights Reserved. No part of this publication may be reproduced or transmitted
in any form or by any means, electronic or mechanical, including photocopy,
recording or any other information storage and retrieval system,
without prior permission in writing from the publisher.
Library of Congress Control Number 2014956046
ISBN 978-0-691-16615-5
Printed and bound in China by Everbest Printing Co. Ltd
10 9 8 7 6 5 4 3 2 1
CONTENTS
Acknowledgments 8
Chapter One
CONFRONTING MADNESS 10
Chapter Two
MADNESS IN THE ANCIENT WORLD 16
Chapter Three
THE DARKNESS AND THE DAWN 48
Chapter Four
MELANCHOLIE AND MADNESSE 86
Chapter Five
MADHOUSES AND MAD-DOCTORS 122
Chapter Six
NERVES AND NERVOUSNESS 162
Chapter Seven
THE GREAT CONFINEMENT 188
Chapter Eight
DEGENERATION AND DESPAIR 224
Chapter Nine
THE DEMI-FOUS 268
Chapter Ten
DESPERATE REMEDIES 290
Chapter Eleven
A MEANINGFUL INTERLUDE 322
Chapter Twelve
A PSYCHIATRIC REVOLUTION? 358
Notes 412
Bibliography 428
Sources of Illustrations 440
Index 441
Acknowledgments
Madness in Civilization is in many ways the product of my more than forty
years of work in the history of madness. During that time, I have accumu-
lated more debts to more people than I can possibly list here. Moreover, in
this book, I attempt a task of surpassing chutzpah, and in doing so, I am
inevitably indebted to the work of countless other scholars – a debt that is
partially, though inadequately, acknowledged in the notes and bibliography
that accompany my text.
However, a number of people have been so extraordinarily kind and
generous in helping me during the course of writing this particular book
that I am delighted to have the chance to thank them here. Though it is but
poor recompense for all they have done for me, I would first like to thank
five people who have been so gracious as to read the entire text, and to send
me detailed comments and suggestions for improvement: William Bynum’s
knowledge of the history of medicine has few equals, and he has saved me
from a multitude of sins, as well as providing much-needed encouragement
along the way. My friends Stephen Cox and Amy Forrest have given every
chapter close and sympathetic readings. They made numerous penetrating
suggestions on matters of style and substance, and did not hesitate to point
out where my writing stumbled, or my arguments seemed to be going astray. I
cannot thank them enough. Every writer should be lucky enough to have such
generous friends. My wonderful editor at Thames & Hudson, Colin Ridler,
has been the sort of publisher every author dreams of: responsive, endlessly
helpful and full of enthusiasm for the project. His colleague Sarah Vernon-
Hunt likewise edited my final draft with exceptional care and attention. In
countless ways I have benefited from her marvellous skills as an editor. As
all these readers can attest, I can be stubborn, and though in many cases
I listened to their sage advice, I sometimes refused to do so. Thus none of
them can in any way be held responsible for the errors of commission and
omission that remain. They do, however, bear a large measure of credit for
whatever virtues my text may possess.
Others have read substantial portions of various chapters, or have
responded to importunate queries of various sorts. I would particularly like
to thank my brother-in-law, Michael Andrews, and my colleagues and friends
Emily Baum, Joel Braslow, Helen Bynum, Colin Gale, Gerald Grob, Miriam
Gross, David Healy, John Marino and Akihito Suzuki. I am grateful as well
8
ACKNOWLEDGMENTS
to various organizations that have helped to make this book possible.
The Academic Senate of the University of California has on many occasions
provided the funds that enabled me to spend time in distant archives.
That assistance has been invaluable for someone concerned with madness’s
past, for the primary sources I have needed to consult are but seldom avail-
able in southern California, its current reputation as the home for the kooky
notwithstanding. Over the years, fellowships and support from the
Guggenheim Foundation, the American Council of Learned Societies, the
American Philosophical Society, the Commonwealth Fund, the Shelby Cullom
Davis Center for Historical Studies at Princeton University, and two University
of California Presidential Humanities fellowships have underwritten major
portions of my research. I am most grateful to them all, since all that prior
labour in the archives has contributed in ways both large and small to the
synthetic work this volume represents.
At my British publisher Thames & Hudson a whole team of people
besides the above-mentioned have provided invaluable assistance with the
preparation of this book, including the design, production and marketing
staff who have transformed my raw text and images into such a handsome
volume. I would like to thank them all. I owe an especial debt of gratitude to
my picture editor Pauline Hubner. Pauline helped me to locate and obtain
permission to use the images that do so much to enhance and enrich the text
and analysis that follow. It is a great pleasure, too, on the North American
side, to have the estimable Peter Dougherty and Princeton University Press
publish another of my books. Peter is a model director of a scholarly press,
and has taken a deep personal interest in the book’s success. I would also
like to thank History of Psychiatry and its long-time editor, German Berrios,
for permission to reprint some text that first appeared in that journal’s 25th
anniversary issue, and that now forms a part of Chapter Eleven.
I love to write, and the dedication of this book reflects how much I owe
to my wife Nancy for all she has done to create the conditions that have made
it possible for me to do so over the years. More importantly, I owe her more
than is in my power to express for her love and companionship over many
decades. Those who have grandchildren will know what joy they bring, and
this book is also dedicated to those Nancy and I are already fortunate enough
to have, and to those we hope to welcome and treasure in years to come.
Andrew Scull
La Jolla, California
9
Chapter One
CONFRONTING
MADN ESS
Madness in civilization? Surely madness is the very negation of civilization?
Enlightenment thinkers, after all, used to argue that Reason is the faculty that
distinguishes human beings from beasts. If that is so, then surely Unreason
is what lies beyond the pale, corresponding in some sense to the point at
which the civilized becomes the savage. Madness is not in civilization, but
something wholly outside it and alien to it.
On reflection, however, matters are not quite so simple. Paradoxically,
madness exists not just in opposition to civilization, or solely on its margins.
On the contrary, it has been a central topic of concern for artists, for dramatists,
novelists, composers, divines, and physicians and scientists, not to mention
how closely it affects almost all of us – either through our own encounters
with disturbances of reason and emotion, or through those of family members
and friends. In important ways, that is, madness is indelibly part of civiliza-
tion, not located outside it. It is a problem that insistently invades our
consciousness and our daily lives. It is thus at once liminal and anything but.
Madness is a disturbing subject, one whose mysteries puzzle us still.
The loss of reason, the sense of alienation from the common-sense world
the rest of us imagine we inhabit,1 the shattering emotional turmoil that
seizes hold of some of us and will not let go: these are a part of our shared
human experience down through the centuries and in every culture. Insanity
haunts the human imagination. It fascinates and frightens all at once. Few
are immune to its terrors. It reminds insistently of how tenuous our own
hold on reality may sometimes be. It challenges our sense of the very limits
of what it is to be human.
10
