Depictions of insanity through history.

Modern psychiatry seems determined to rob madness of its meanings, insisting that its depredations can be reduced to biology and nothing but biology. One must doubt it. The social and cultural dimensions of mental disorders, so indispensable a part of the story of madness and civilization over the centuries, are unlikely to melt away, or to prove no more than an epiphenomenal feature of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been.

Western culture throughout its long and tangled history provides us with a rich array of images, a remarkable set of windows into both popular and latterly professional beliefs about insanity. The sacred books of the Judeo-Christian tradition are shot through with stories of madness caused by possession by devils or divine displeasure. From Saul, the first king of the Israelites (made mad by Yahweh for failing to carry out to the letter the Lord’s command to slay every man, woman, and child of the Amalekite tribe, and all their animals, too), to the man in the country of the Gaderenes “with an unclean spirit” (maddened, naked, and violent, whose demons Christ casts out and causes to enter a herd of swine, who forthwith rush over a cliff into the sea to drown), here are stories recited for centuries by believers, and often transformed into pictorial form. None proved more fascinating than the story of Nebuchadnezzar, the mighty king of Babylon, the man who captured Jerusalem and destroyed its Temple, carrying the Jews off into captivity all apparently without incurring divine wrath. Swollen with pride, however, he impiously boasts of “the might of my power,” and a savage and jealous God has had enough: driven mad, he “did eat grass as oxen, and his body was wet with the dew of heaven, till his hairs were grown like eagle’s feathers, and his nails like bird’s claws.” The description has proved irresistible to many an artist: above, an unknown German artist working in early fifteenth-century Regensburg provides a portrait of the changes madness wrought upon the sane.

Disease was rife in the ancient, medieval, and early modern world. It was often interpreted through a religious lens, and the spread of Christian belief through pagan Europe was often facilitated by the use of miracles and wonders to demonstrate the power of the Christian God. The ability to cure sick and tortured souls was increasingly brought about by the intercession of saints and martyrs, whose relics were believed to have miraculous power to heal the sick, reanimate the halt and the lame, and restore sight to the blind. The tombs of saints like St. Margaret of Antioch and St. Dymphna of Geel, who had both been beheaded, were popular choices for those seeking relief from mental distress, as was the shrine of St. Thomas à Becket, whose murder in Canterbury Cathedral is here shown in a mid-thirteenth-century codex. The saint’s blood was thought to cure insanity, blindness, leprosy, and deafness, not to mention a host of other ailments.

Naturalistic accounts of madness, those that saw its roots in the body, had an ancient lineage as well. Though many in classical Greece and Rome still embraced supernatural accounts of mental disturbance and had recourse to the temple medicine of the god Asclepius, with its purification rites, charms, and spells, others were attracted to the humoral model of disease embraced by the followers of Hippocrates and later systematized by the Graseco-Roman physician Galen—a model of illness, both mental and physical, that would survive in Europe into the nineteenth century. Hieronymus Bosch’s satirical painting of The Cure of Folly: The Extraction of the Stone of Folly, which dates from c. 1494, suggests that skepticism about medical claims remained widespread despite physicians’ best efforts. A doctor dressed in a dunce’s cap uses a scalpel to draw forth the supposed cause of madness from the scalp of a patient.

Though religious interpretations of mental disturbance persisted in both polite and popular circles well into the eighteenth century (and among hoi polloi even longer than that), medical models of mental disorder gradually became the dominant and then almost the only legitimate interpretation of the sources of mental distress. The eighteenth century saw the rise in England, the first consumer society, of a private trade in lunacy. Mad-doctors, as they were then called (the double entendre would later cause specialists in the management of lunacy to search for a more respectable name), marketed their madhouses as ways to save affluent families from the travails and potential disgrace of keeping a lunatic at home, and over time began to claim the ability to cure as well as immure the insane. The technological inventiveness of the Industrial Revolution was soon extended to devices intended to shock and startle the mad back to their senses. Erasmus Darwin, Charles Darwin’s grandfather, suggested a swinging chair, and soon a variety of such devices were marketed, one promising that by “increasing the velocity of the swing, the motion be[ing] suddenly reversed every six or eight minutes … the consequence is, an instant discharge of the stomach, bowels, and bladder, in quick succession.” Others promoted a variety of devices designed to simulate drowning—though sometimes, unfortunately, the drowning proved all too real. And the American mad-doctor, Benjamin Rush, created a special chair, one that “binds and confines every part of the body … Its effects have been truly delightful to me. It acts as a sedative to the tongue and temper as well as to the blood vessels. I have called it a Tranquillizer.”

Aristotle had seen the heart as the seat of the emotions and the intellect. By contrast, the Hippocratics saw the brain as their center. The anatomical investigations of the late seventeenth-century Oxford physician Thomas Willis (the man who coined the term neurologie) had given new impetus to the study of the role of the brain and the nervous system, and by the early nineteenth century, few medical men doubted that the etiology of insanity could be traced to disorders of the nerves and the brain. Among the most talented early nineteenth-century anatomists of these organs were the Austrian physicians Franz Gall and J.G. Spurzheim, who viewed the brain as a congeries of organs, each region corresponding to particular psychological functions. They asserted that the relative size of a particular organ was indicative of the strength of a particular mental function and that its size could be increased or decreased through mental exercise, rather as muscles can be developed or can atrophy. As the cranial bones developed, they allegedly conformed to the underlying comparative development of the brain’s different parts. Thus, a person’s mental capacities could be deduced from the confirmation of the head. Phrenological claims to provide a guide to human capacities and a somatic account of the origins of insanity soon became the butt of ridicule (as can be seen in this caricature, where Gall himself examines the head of an attractive young woman, while three gentlemen wait their turns to have their own characters read). Yet Gall’s underlying doctrine of cerebral localization enjoyed a long half life in neurology.

The handful of profit-making madhouses that emerged in the eighteenth century were dwarfed by the Great Confinement of the insane that marked the nineteenth. States all across Europe and North America embraced the asylum solution, prompted in part by the assurances of the medical men who soon monopolized the running of these places that they were architectural contrivances uniquely suited to the management and cure of the mentally disturbed. It was within the walls of the asylum that alienists (as many now called themselves) developed and articulated their claims to expertise, and sought to manage the madness of those they confined. Their textbooks recorded their encounter with the insane. Early in the nineteenth century, many still had recourse to various forms of mechanical restraint, as this 1838 illustration from the French alienist J.E.D. Esquirol vividly shows.

Later, many asylum doctors sought to distance themselves from such devices, proclaiming that they could manage the mad through moral suasion alone. The ancient divisions of insanity into such subtypes as mania, melancholia, and dementia were amended as alienists sought to persuade politicians and the public at large that their expertise allowed them to distinguish whole new realms of madness, each with their own characteristic features. If phrenology’s claims had been abandoned, the notion that madness might be read from the physiognomy of the face had not. Hence, the first major English-language textbook of the new asylum age, John Charles Bucknill’s and Daniel Hack Tuke’s A Manual of Psychological Medicine (1858) carried as its frontispiece an illustration of “Types of Insanity”—and, later in the century, Charles Darwin sought in the countenances of insane patients at the West Riding County Asylum in Yorkshire to uncover The Expression of the Emotions in Man and Animals (1872).

The asylum era had been launched amidst utopian expectations of cure. Its failure to deliver on its early promises brought about a rapid deterioration in its reputation, and increasingly, a portrait of the inmates of asylumdom as a biologically degenerate lot. Desperate to avoid the stigma of certification and confinement in what came to be seen as cemeteries for the still-breathing, nervous patients of means flocked instead to a variety of homes for the nervous, where they were treated with hydrotherapy, vegetable diets, massage, programs of rest and of exercise, and a variety of electrical treatments—stimulation from impressive machines constructed of brass and chrome to create and dispense static electrical shocks to arouse torpid nervous systems; and more targeted therapy from electrical vibrators, as shown here.

Arguably, the most prominent of these places was the Battle Creek Sanitarium run by the Kellogg brothers, which entertained presidents, industrial magnates and Hollywood stars in the first decades of the twentieth century, where in addition to the delights listed above, they were treated with phototherapy, the strategic manipulation of light.

A different class of nervous patient thronged the wards of one of the great Paris hospitals for the poor. Here the self-described Napoleon of the Neuroses, Jean-Martin Charcot, had built his career by distinguishing a variety of awful neurological afflictions, from disseminated multiple sclerosis; aphasia; amyotrophic lateral sclerosis (better known to most Americans as Lou Gehrig’s disease); Tourette’s syndrome, chorea; locomotor ataxia (a complication of tertiary syphilis, as would become apparent in the early twentieth century); and so on. But what later drew his attention was one of the great epidemic diseases of the age, a disorder that has now disappeared from the psychiatric lexicon: hysteria. Weekly, in an amphitheater in front of tout Paris, he hypnotized a parade of scantily clad young women, many of them repeat performers. The patients staged (and that is the appropriate word), the various stages of a hysterical fit: the seizures and the impossible bodily contortions of course, but more entertainingly still, the attitudes passionelles, the emotional gestures, cries and whispers that displayed unmistakably erotic overtones. And then they were re-hypnotized in private, so that they could hold their poses for the primitive cameras of the age, thus allowing their images to be reproduced and shown to a still larger virtual audience in the volumes of the Iconographis Photographique de la Salpêtrière.

Of course, we denizens of the twenty-first century have moved beyond all this frippery and superstition. We live in an age of medical science, where even the formerly dark art of psychiatry has advanced into modernity. Just as penicillin symbolizes the age of the magic bullet in general medicine, the advent of a cure for formerly deadly bacterial infections, so too, at last, mental illness has its miracle drugs: the antipsychotics that arrived on the scene with the introduction of Thorazine in 1954, soon followed by the minor tranquillizers like Miltown and Valium, till we all entered upon the promised era when we all became “better than well” and embraced Prozac Nation.

On second thoughts, perhaps not. Neither the antipsychotics nor the antidepressants, minor or major, are a psychiatric penicillin. To the contrary, they are at best a Band-Aid, a set of palliative measures that damp down the florid symptoms of psychosis (and perhaps rein in the violence that accompanies it—as in the accompanying early advertisement for the wonders of Thorazine), but often do not work as advertized, and for many bring with them a set of disabling iatrogenic (physician-caused) side effects: neurological tics and disturbances that are the often-permanent stigmatizing signs of tardive dyskinesia, emotional numbing, sexual impotence, massive weight gain, and life-threatening metabolic disorders.

A half century ago, the Rolling Stones sang a mordant song celebrating the “Mother’s Little Helper,” the little yellow pill that tranquilized bored housewives everywhere as it hurried them along to their “busy dying day.” Some younger folks might consider it a welcome solution to the problem of “what a drag it is getting old.” As my final image suggests, however, drug companies have preferred to market it as a solution to the travails of those trapped in an endless round of housework.

It would appear that even in the age of the psychopharmacological revolution, we cannot escape the meanings that attach themselves like limpets to the phenomenon that is madness.

Andrew Scull is the author of Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine and distinguished professor of sociology and science studies at the University of California, San Diego. His books include Hysteria: The Disturbing History, Madhouse: A Tragic Tale of Megalomania and Modern Medicine, and Masters of Bedlam: The Transformation of the Mad-Doctoring Trade. He lives in La Jolla, California.

Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine is available now.