Madness: A Brief History

Mr. Porter, in this small book, traces the development of thought about madness from pre-history through post-modern psychology. Excellently done, in a way that makes each developmental step make sense.

Arguments that favor and potentially dismantle the social construction of "madness" illumine Roy Porter's brief history of Bedlam. So-called progress as co-requisite with modernity in building, and later dismantling, structures of caring for the mentally ill faces stiff opposition in these tight 241 pages, 6.5 X 4.5 in. format. Most proponents of "progress" might feel mad about Porter's understated conclusions that he draws from numerous examples of ancient philosophies still achieving measured relief for the tortures of madness. It could be that some gods and demons resist rationality and its therapeutic judgments as madness. Latent in Porter's argument is the tortured mind as self-referential and enigmatic in structure or form as well as content. Also latent is the reference to self as therapy to loose the Gordian knot of madness. Porter's measured steps credit and explore arguments from Szasz and Foucault, as favoring the construction of madness, and their opponents who include philosophers and medical scientists advancing practical materialist theories of varied stripes. However, Porter need not inflame opposing sides among readers, for his project lays no claim to polarized theories of madness. Rather, he bridges centuries of madness with architecture that has withstood tests of time. Chronology supports these bridges, beginning with Pre-Socratic philosophers who presaged contemporary holistic mental health practices with community and common-sense recommendations. Each generation of caring for the sick of mind is traced by identifying prevailing thematic trends and providing evidence of success and failure to treat or cure, contain, or dismiss madness. Tracking history is a familiar enterprise of Porter's; each step raises a surprise. Familiar and surprising, all the same, care reforms from the 18th-century onward seldom restructured madness. For this reason alone, this book ought to become mandatory reading for politicians, mental-health students, humanitarian agency personnel, and everyone who ever wanted to control the thinking and behavior of anyone--including the self who pens these words--by entertaining less, in length of historical pages, and not more. Progressives and conservatives alike, who explore madness in Porter's brief history, may well achieve a lasting and ancient reform.

Ror Porter's excellent book places the history of madness within specific social contexts. We get a full picture of the perception of madness primarily as an emblem of difference which serves as a trigger for rejection by the dominant social forces of communities. Individuals outside the dominant social groups are confined, placed in asylums, and made invisible; Porter reveals to us that the "mad" weren't necessarily ill or disordered, but often individuals that were seen as a blight on the facade of cities---single women, orphaned children, the disabled, or artists whose freedom was considered a threat to more conservative rulers of town and country. Porter's description of madness as illness is equally compelling. He writes with elegance, style, and clarity. Highly recommended.

This book was like nothing I have ever read before. The detail that was shown throughout the book really was able to make me see what it might have looked like, sounded like, felt like and sometimes even smelled like being in an asylum. The amount of information that Roy Porter put into this book was amazing. You might have thought he haad been in an asylum himself. I would absolutely recommend this book to anyone.

Roy Porter died recently at the age of 55, but produced over eighty books on a wide range of subjects, from the Enlightenment to the English treatment of insanity in various historic periods. It would not be surprising if this polymath has other manuscripts awaiting publication, but _Madness: A Brief History_ (Oxford University Press) was his last production before his death. It is a remarkable work especially for its brevity, taking in prehistoric concepts of madness and ranging all the way into current psychiatric controversies in less than 250 clear, well-researched pages. There have been fashions of treatments for the mentally ill, and just a bit of scientific justification for them most recently, but one of the points of his treatise is to show that we aren't any closer to true definitions of madness than Polonius was: to "define true madness,/ What is't but to be nothing else but mad?" His own lack of definition enables this brief overview to take in a great deal of territory.Porter examines the imposition of madness by the gods in Homer. By the time of Hippocrates (around 400 BCE) madness was a medical, not moral or magical, matter. But supernatural explanations for insanity were advanced again, along with the angels and demons sanctioned by the Christian church. Around the Renaissance, the concept arose that madness was a special sort of inspiration. (There remains folk wisdom that geniuses are not at all far removed from the insane.) Families had originally had the responsibility for lunatic progeny, but the surplus wealth of urban areas encouraged families to buy such services. At the beginning of the nineteenth century in England, confined lunatics were largely in private asylums under what was literally called "the trade in lunacy." Optimism that "moral treatment" might cure such cases was disappointed; in the last of the nineteenth century, a pessimism took over, as few were cured and the asylums became clogged with inmates whose needs were severe. Security and sedation were promoted as the numbers grew. Armed with new classifications of different styles of madness, doctors continued to be frustrated by an inability to change much; one German asylum doctor said, "We know a lot and can do little."With the revolution in pharmaceuticals in the twentieth century, this changed. Patients were able to leave the asylums, and the medicines promised improvement without long stays in the hospital, long bouts of psychoanalysis, or irreversible psychosurgery, as well as promoting psychiatrists as "real doctors." This is a remarkable book, which is able to take a broad historical view; there are far larger tomes on this subject, and indeed on subjects which here necessarily get only a paragraph or so, but the sweep of the coverage is impressive. Porter ends his summary with unnecessary pessimism. It is true that the last century had its share of abuse of the mentally ill (one does not even have to cite the extremes of Nazi and Sov