Madness in Civilization:A Cultural History of Insanityby Andrew ScullPrinceton University Press, 2015Thanks to the hyper-medicated and reality-doubting nature of the 21^st century West, any study of the history of mental illness must start by defining its terms; the assumption that stark insanity is self-evident is itself no longer self-evident. So it is that Andrew Scull, in his magnificent new book Madness in Civilization, must first explain what he means by “madness,” which he does with eloquent testiness in his book's early pages:

In my view madness – massive and lasting disturbances of reason, intellect and emotions – is a phenomenon to be found in all known societies, one that poses profound challenges of both a practical and a symbolic sort to the social fabric, and to the very notion of a stable social order. The claim that it is all a matter of social construction or labels is to my mind so much romantic nonsense, or useless tautology. Those who lose control of their emotions, whether melancholic or manic; those who do not share the common-sense reality most of us perceive and the mental universe we inhabit, who hallucinate or make claims about their existence that people around them conclude are delusions; those who act in ways that are profoundly at variance with the conventions and expectations of their culture, and are heedless of the ordinary corrective measures their community mobilizes to induce them to desist; those who manifest extremes of extravagance and incoherence, or who exhibit the grotesquely denuded mental life of the demented; these form the core of what we look upon as irrational, and are the population that for millennia was regarded as mad, or referred to by some analogous term.

Scull's book is a comprehensive study of that “grotesquely denuded mental life” through the ages of human civilization, starting with quasi-mythical accounts in the Bible and Homer and ranging forward in time epoch by epoch, through the torturous under story of saints' lives to the freak shows of the Renaissance to Robert Burton's 1621 magnum opus The Anatomy of Melancholy. The progress of treatment is even more halting than even the agonizingly slow progress of medicine itself, and Scull digresses often to describe the countless abuses that arose over the centuries, including the prevalence in the 18^th century of the practice of sane people being committed to asylums by scheming family members for financial reasons (William Belcher, wrongly confined to such an asylum from 1778 to 1795, was one such person, who referred to his ordeal as a “premature coffin of the mind”).But it's Scull's treatment of those asylums themselves – his “empire of asylumdom” - that forms the highlight of Madness in Civilization, his historical excavation of these miserable places where the insane were warehoused and experimented upon and tortured in a prolongation and intensification of their original misery that's almost impossible to read about. That misery brings out Scull's most elegiac prose:

As late as the 1960s, Central State Hospital in Milledgeville, Georgia, still housed upwards of twelve thousand patients, making it the largest mental hospital in the world. Now, its two hundred buildings scattered across nearly 2,000 acres stand empty, many falling in on themselves. No one in the future will ever encounter the sights and sounds that once greeted those who ventured into its hallways – or the characteristic smells that marked asylums like this: the unforgettable odour of decaying bodies and minds, of wards impregnated with decades of human waste, of the slop served up for generations as food, the unsavoury concoction clinging like some foul miasma to the physical fabric of the buildings. Outside, in the ill-tended grounds, thousands of graves lie half-hidden, numbered metal tags marking the final fate of many of those once confined for years on end.

(Years ago, I walked around the dilapidated rooms of the old Grafton State Hospital in Grafton, Massachusetts during the long period when it was abandoned, and you could swear that the hopeless, howling sadness of the place could still be heard in echoes; it was the only place I've ever been in my life that actually felt haunted)Scull notes that the enormously widespread use of asylums began a rapid decline with the advent of psychiatric drugs in the mid-20^th century, and he regards the rise of that industry – and the prevalence of its bible, the DSM 5 and its earlier editions, in the staggeringly profitable trade of psychiatric drugs of all kinds pushed by the world's gigantic pharmaceutical companies, so-called “Big Pharma.” Those drugs, Scull argues quite correctly, are the hinge on which turns a great deal of fraud:

For psychiatric drugs have been a central part of Big Pharma's expansion and its profits. That is not because we possess a psychiatric penicillin. Quite the contrary: for all the marketing hype surrounding psychopharmacology, its pills and potions are palliative, not curative – and often not even that. But ironically, it is precisely the relative therapeutic impotence of psychotropic drugs that has made them so valuable, and has vaulted them so regularly into the ranks of the so-called blockbuster drugs, those that amass north of a billion dollars in profits for the industry. Drugs that cure are great – for the patient.

The 19th-century “mad doctor” John Haslam once testified in court “I never saw any human being who was of sound mind,” and both Big Pharma and the psychiatric industry have battened onto exactly this kind of inanity, with predictably jaw-dropping statistical results:

The loosening of diagnostic criteria led to an extraordinary expansion of the numbers of people defined as mentally ill. This has been particularly evident among, but by no means confined to, the ranks of the young. 'Juvenile bipolar disorder,' for example, increased forty-fold in just a decade, between 1994 and 2004. An autism epidemic broke out, as a formerly rare condition, seen in less than one in five hundred children at the outset of the same decade, was found in one in every ninety children only ten years later. The story of hyperactivity, subsequently relabeled ADHD is similar, with 10 percent of male American children now taking pills daily for their 'disease.' Among adults, one in every seventy-six Americans qualified for welfare payments based upon mental health disability in 2007.

Madness in Civilization is a landmark study, as authoritative as it is readable in its account of the devastatingly sad understory of human society. It's enraging, intensely unsparing reading, but it's a masterpiece.