The Mentally Ill Have Never Had It Easy

How society as viewed those deemed mad has never been pleasant. What will future generations think about how we treat the mentally ill today?


Among the many systems designed and evolved to maintain clean lines of separation between groups, perhaps few remain as unexplored as those barriers between the mentally well and the mentally ill.

Despite society’s fascination with mental illness, be it in advocacy, uncertainty or blame, the myriad ways in which those two worlds collide and interact remain largely a topic lacking in widespread critical examination. Andrew Scull, professor of sociology at UC-San Diego, has sought to remedy that with an engrossing and far-reaching look at the ways that culture and mental illness have interacted throughout history in his latest book, Madness in Civilization.

The history of mental illness, or madness and lunacy as Scull uses for most of the book, is by nature a devastating subject. The abject neglect and inhumane treatment that characterized “treatment” for centuries occupies the same space as ghost stories and serial killers in our cultural consciousness. Scull’s account of the long and dark evolution of our understanding of mental illness could easily have become little more than a sideshow. But the wide view of science, religion, culture, and madness offered in the book makes a far more compelling story.

Beginning in antiquity and tracing the major shifts in how society views both the manifestation and the subsequent treatment of mental illness through today, Scull is less concerned with the mentally ill themselves than the idea of insanity. His narrative rest firmly on the words and records of the men who shaped public perception of and official policy on mental illness. By looking at the way madness fits into the larger cultural context throughout history, readers are offered a unique view of insanity itself. Here mental illness is not alien to society or threatening to it, but instead an active and ever-changing part of the larger picture. Scull has made a stigmatized community’s role in culture the central focus of his work, and by so doing torn down the presuppositions of what madness means to civilization.

Among the most striking features of the story of mental illness is perhaps how speculative the study and treatment has been, and how recently our modern understanding evolved. Scull’s narrative steps from subtle change to subtle change, starting with the long-held belief that mental illness was under the purview of religion. Possession by demon may seem anachronistic at best today, but for a millennia it defined not just the way society approached the mentally ill, but also their treatment. The power of prayer and exorcism to heal the unwell was beyond reproach for most of human history. Interestingly, the change in perception of mental illness that facilitated the trajectory toward treatment as we know it came in part because of religious embrace of the idea that the brain could be at fault while the mind (and soul) are not, which removed mental illness from the domain of faith and shifted it into secular hands. Of course, to call those who took over from the church “medical” professions would be disingenuous, if not outright wrong.

Scull’s exploration is by no means limited solely to treatment of mental illness. He also looks at the ways in which popular and high culture appropriated the stories of mental illness, as well as the expression of personal experiences in artists’ works. From Shakespeare’s Ophelia to celebrated opera to One Flew Over the Cuckoo’s Nest, Scull illustrates the use of madness in satire, for humor, to horrify and to challenge cultural norms. The various uses of the “fool” or the institutionalized madman both refute and speak to the idea that madness is outside of civilization. On one hand, insanity is a tool that can turn a character into whatever is needed—a mirror for hypocrisy, a reminder of the cruelty of man, or comic relief. On the other, it’s a constant presence in the arts and culture we consume, with the fourth wall acting to temper our exposure. Insanity is kept at a safe distance, even when it’s right in front of us.

For much of history the mentally ill have been largely without agency, and Scull’s book is true to that. The voices of those treated throughout history are muted, with occasional interjections from well-known persons who were subjected to various treatments. Ernest Hemingway’s suicide note and Sylvia Plath’s The Bell Jar are quoted on electroshock therapy, but by and large the suffering of the mentally ill is voiced by those who are merely concerned citizens rather than patients.

But the focus of the book is never on the mentally ill themselves, but on civilization. By relying less on depictions of tales of horror in asylum wards, Scull is able to bring the conversation about mental illness away from the margins of medicine and turn the spotlight on culture en mass. Readers are observing the observers rather than the observed. There are no attempts to categorize the mentally ill throughout history or lend modern understanding to past assumptions. Instead, Scull gives readers a portrait of the sane grappling with the Other among them.

Scull, though critical, does not attempt to rationalize or demonize past treatments and beliefs. Given the wide range of time covered—really, the history of humanity—he is able to show the steps that have led us to our modern understanding of mental illness. This serves to illustrate that this evolution has been constant up until today, and will continue into the future. Scull doesn’t woo the reader with some romanticized idea that we have achieved a full and correct understanding of mental illness, and instead the reader is left wondering how history will look back at this period.

There are faults in the book. The length, though manageable, is made to feel even more daunting by extensive context detailing and biographical information, which at times overshadows the way the specific subject matter relates back to the overall topic. Although early on Scull discusses non-Western cultures at length, the bulk of the book looks only at the West with a few mentions of Western influence in colonized states. These flaws are pronounced and felt throughout the book, but nonetheless it remains a fascinating and engrossing read.

With Madness in Civilization, Andrew Scull has woven together seemingly disparate areas to create a well-rounded and complex picture of how society interacts with mental illness. By turns disturbing, enlightening and moving, Madness in Civilization is an accessible and enjoyable look at an often neglected part of humanity’s history.