Abstract
Is madness medical disease, problems in living, or social labeling of deviance? Does the word merely refer to behavior peculiar enough to be disturbing? Are the mad mad because of mental, physical, or environmental vulnerabilities? No one knows the answers to these questions because there is no scientific validation for any theory or specific causes of madness. Nonetheless, a view of madness as medical/bodily disease has been receiving concrete and rhetorical support from the government mental health bureaucracy, Big Pharma, mental health lobby groups, the organized profession of psychiatry, hundreds of thousands of providers of mental health services and countless books and articles. This article explores the role that medicalized language and its use by seven noted historians of psychiatry (Norman Dain, Albert Deutsch, Gerald Grob, Roy Porter, Charles Rosenberg, Andrew Scull, and Edward Shorter) might have played in shaping the contemporary view of madness as mental illness. The evidence we uncover suggests that historical “facts” about madness, much as psychiatric “facts” supporting the disease model, are shaped by belief, bias, error or ambiguous rhetoric rather than the facts of the matter.
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Notes
We tend to agree with Thomas Szasz that the better term for the coercive paternalistic approach accepted by most psychiatrists is the pediatric model, since typically other physicians treat adults who seek their services. Only pediatricians and psychiatrists treat persons who do not seek their services. Pediatricians treat children often against their but not their parents’ will because by law children cannot make independent decisions about their welfare, while psychiatrists by law can treat adults against their will by dealing with them as if they where irresponsible children (Szasz 1987, p. 91).
This is similar to the term behavioral health, whose use in the medical and psychological literature first appeared in the 1970s and dramatically spiked starting in the mid-1990s (see, for example, Google’s ngram using this term). This obvious metaphor appears well-suited for its primary purposes, as far as we can discern them at present: to justify both the increased involvement of psychologists and social workers in the health care arena and the increased and renewed involvement of physicians in changing patients’ behaviors.
This begs the question of what in the “center” of madness, as opposed to its margins, is invariable and unambiguous.
Szasz—described by Micale and Porter in their edited volume Discovering the History of Psychiatry (1994) as “offer[ing] fundamental rereadings of exemplary episodes and topics in the history of mental medicine” (p. 23) worthy of a full chapter in that book—has never asserted what Scull (1993) and many other of his critics claim to be Szasz’s position, namely, that mental alienation is merely the result of social labeling and scapegoating and is a myth. Szasz argues that emotional difficulties and tragedies are real, but result from the minor and serious problems that people experience while trying to make a life, rather than the consequence of biological pathology. He suggested that “[t]o regard ‘minor’ upheavals in living as problems in human relations, learning and so forth—and more ‘major’ upheavals as due to brain disease, seems to be a rather simple example of wishful thinking” (Szasz 1961, p. 94). In his first and most often cited but rarely fully understood classic, the Myth of Mental Illness (1961), Szasz did not write a polemic full of simplistic claims as Scull asserts (2011, p. 100), but rather a detailed and scholarly treatise outlining, as its subtitle states, the “foundations of a theory of personal conduct.” Using a combination of semiotic, rule-following, and game-model analysis, Szasz proposes a theory of human behavior applicable to both the “normal” and “deviant.”
References
American Psychiatric Association. (2000). Diagnostic and statistical manual, 4th edition, text revision. Washington DC: American Psychiatric Association.
Andreasen, N. C. (1997). Linking mind and brain in the study of mental illnesses: a project for a scientific psychopathology. Science, 275, 1586–1593.
Bentall, R. P. (Ed.). (1990). Reconstructing schizophrenia. New York: Routledge.
Berrios, G., & Porter, R. (Eds.). (1995). A history of clinical psychiatry. New Brunswick: Athlone Press.
Boyle, M. (2002). Schizophrenia: A scientific delusion? New York: Routledge.
Bruner, J. S., Goodnow, J. J., & Austin, G. A. (1986). A study of thinking. New Brunswick: Transaction, Inc.
Conrad, P., & Schneider, J. W. (1992). Deviance and medicalization: From badness to sickness. Philadelphia: Temple University Press.
Dain, N. (1964). Concepts of insanity. New Brunswick: Rutgers University Press.
Deutsch, A. (1967). The mentally ill in America. New York: Columbia University Press.
Engstrom, E. J. (2000). Zeitgeschichte as disciplinary history: on professional identity, self-reflexive narratives, and discipline-building in contemporary German history. Tel Aviver Jahrbuch für deutsche Geschichte, 29, 399–425.
Engstrom, E. J. (2008). Personal communication, October, 9, 2008.
Goffman, E. (1961). Asylums: Essays on the social situations of mental patients and other inmates. Oxford: Doubleday.
Goldman, H. H., & Grob, G. N. (2006). Defining “mental illness” in mental health policy. Health Affairs, 25, 737–749.
Grob, G. N. (1966). The state and the mentally ill: A history of Worcester State Hospital in Massachusetts. Chapel Hill, NC: University of North Carolina Press.
Grob, G. N. (1973). Mental institutions in America: Social policy to 1875. New York: Free Press.
Grob, G. N. (1983). Mental illness and American society: 1875–1940. Princeton: Princeton University Press.
Grob, G. N. (1991). From asylum to community: Mental health policy in modern America. Princeton: Princeton University Press.
Grob, G. N. (1994a). The history of the asylum revisited: Personal reflections. In M. S. Micale & R. Porter (Eds.), Discovering the history of psychiatry (pp. 260–281). New York: Oxford University Press.
Grob, G. N. (1994b). The mad among us: A history of the care of America’s mentally ill. Cambridge: Harvard University Press.
Grob, G. N. (1998). Psychiatry’s holy grail: the search for the mechanisms of mental diseases. Bulletin of the History of Medicine, 72, 189–219.
James, W. (1890/1981). The principles of psychology. Cambridge, MA: Harvard University Press.
Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad science: Psychiatric coercion, diagnosis, and drugs. New Brunswick: Transaction Publishers.
Kupfer, D. J., First, M., & Regier, D. A. (Eds.). (2002). A research agenda for DSM-V. Washington, DC: American Psychiatric Association.
Micale, M. S., & Porter, R. (Eds.). (1994). Discovering the history of psychiatry. New York: Oxford University Press.
Minogue, K. (1985). Alien powers: The pure theory of ideology. London: Palgrave Macmillan.
Popper, K. R. (1989). Conjectures and refutations. London: Routledge.
Porter, R. (1987a). A social history of madness. New York: Weidenfeld and Nicolson.
Porter, R. (1987b). Mind-forg’d manacles: A history of madness in England from the Restoration to the Regency. Cambridge: Harvard University Press.
Porter, R. (2002). Madness: A brief history. New York: Oxford University Press.
Read, J., Mosher, L. R., & Bentall, R. P. (Eds.). (2004). Models of madness. New York: Brunner-Routledge.
Rosenberg, C. (2006). Contested boundaries: psychiatry, disease and diagnosis. Perspectives in Biology and Medicine, 49(3), 407–424.
Rosenberg, C. E. (2007). Our present complaint: American medicine, then and now. Baltimore: John Hopkins University Press.
Scheff, T. J. (1966). Being mentally ill: A sociological theory. Chicago: Aldine Press.
Scull, A. (1979). Museums of madness: The social organization of insanity in nineteenth century England. New York: St. Martin’s Press.
Scull, A. (1990). Deinstitutionalization: cycles of despair. Journal of Mind and Behavior, 11, 301–312.
Scull, A. (1993). The most solitary of afflictions. New Haven: Yale University Press.
Scull, A. (1995). Psychiatrists and historical “facts” part two: re-writing the history of asylumdom. History of Psychiatry, 6, 387–394.
Scull, A. (2011). Madness: A very short introduction. New York: Oxford University Press, Inc.
Shorter, E. (1997). A history of psychiatry. New York: Wiley.
Shorter, E. (2005). A historical dictionary of psychiatry. New York: Oxford University Press, Inc.
Shorter, E. (n. d.). Interview. Retrieved from http://www.ibiblio.org/pub/electronic-publications/stay-free/archives/21/edward_shorter.html.
Szasz, T. (1961). The myth of mental illness. New York: Hoeber.
Szasz, T. (1987). Insanity: The idea and its consequences. New York: Wiley.
Szasz, T. (2007). Coercion as cure: A critical history of psychiatry. Somerset: Transactions Publishers.
Turbayne, C. M. (1970). The myth of metaphor. Columbia: University of South Carolina Press.
U.S. Department of Health and Human Services. (1999). Mental Health: A report of the surgeon general. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Weiss, K. J. (2011). Images in psychiatry. The American Journal of Psychiatry, 168(3), 252.
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This article is adapted from Mad Science: Psychiatric Coercion, Diagnosis, and Drugs, Copyright c (2013) by Transaction Publishers. Reprinted by permission of the publisher.
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Gomory, T., Cohen, D. & Kirk, S.A. Madness or Mental Illness? Revisiting Historians of Psychiatry. Curr Psychol 32, 119–135 (2013). https://doi.org/10.1007/s12144-013-9168-3
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DOI: https://doi.org/10.1007/s12144-013-9168-3