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Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine
The loss of reason, a sense of alienation from the commonsense world we all like to imagine we inhabit, the shattering emotional turmoil that seizes hold and won’t let go—these are some of the traits we associate with madness. Today, mental disturbance is most commonly viewed through a medical lens, but societies have also sought to make sense of it through religion or the supernatural, or by constructing psychological or social explanations in an effort to tame the demons of unreason. Madness in Civilization traces the long and complex history of this affliction and our attempts to treat it.
Beautifully illustrated throughout, Madness in Civilization takes readers from antiquity to today, painting a vivid and often harrowing portrait of the different ways that cultures around the world have interpreted and responded to the seemingly irrational, psychotic, and insane. From the Bible to Sigmund Freud, from exorcism to mesmerism, from Bedlam to Victorian asylums, from the theory of humors to modern pharmacology, the book explores the manifestations and meanings of madness, its challenges and consequences, and our varied responses to it. It also looks at how insanity has haunted the imaginations of artists and writers and describes the profound influence it has had on the arts, from drama, opera, and the novel to drawing, painting, and sculpture.
Written by one of the world’s preeminent historians of psychiatry, Madness in Civilization is a panoramic history of the human encounter with unreason.
448 pages, Kindle Edition
First published March 23, 2015
277 people are currently reading
5487 people want to read
About the author
Andrew Scull
25 books81 followersAndrew T. Scull (born 1947) is a British-born sociologist whose research is centered on the social history of medicine and particularly psychiatry. He is a Distinguished Professor of Sociology and Science Studies at University of California, San Diego and recipient of the Roy Porter Medal for lifetime contributions to the history of medicine. His books include Madhouse: A Tragic Tale of Megalomania and Modern Medicine and Madness in Civilization: A Cultural History of Insanity.
Scull was born in Edinburgh, Scotland, the son of Allan Edward Scull, a civil engineer and Marjorie née Corrigan, a college teacher. He received his BA with first class honors from Balliol College, Oxford. He then studied at Princeton University, receiving his MA in Sociology in 1971 and his Ph.D. in 1974. He was a postdoc at University College London in 1976-77.
Scull taught at the University of Pennsylvania from 1973 until 1978 when was appointed to the sociology faculty at University of California, San Diego as an Associate Professor. He was appointed a full professor in 1982, and Distinguished Professor in 1994.
Scull was born in Edinburgh, Scotland, the son of Allan Edward Scull, a civil engineer and Marjorie née Corrigan, a college teacher. He received his BA with first class honors from Balliol College, Oxford. He then studied at Princeton University, receiving his MA in Sociology in 1971 and his Ph.D. in 1974. He was a postdoc at University College London in 1976-77.
Scull taught at the University of Pennsylvania from 1973 until 1978 when was appointed to the sociology faculty at University of California, San Diego as an Associate Professor. He was appointed a full professor in 1982, and Distinguished Professor in 1994.
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Displaying 1 - 30 of 94 reviews
September 7, 2016
Rivetingly interesting and will require a re-read or 6 - there is so much meat in here that I know I haven't yet wrung it dry! I especially liked the cover, very clever indeed. Excellent illustrations throughout add context. Scull defines madness as 'massive and lasting disturbances of reason, intellect and emotions' We do see here the first evidence of the medical model as there is no mention of spiritual disturbance nor of group phenomena, though I am guessing he has inferred the understanding that he means only the individual. He does deal with spiritual/religious beliefs about madness but in the context of the history, not the present or the personal. Thus the spiritual is forever 'over there' as far as this book is concerned. This is my main complaint; it's an excellent history aside from this and I'd be delighted to own a copy.
August 5, 2015
"O let me not be mad, not mad, sweet heaven!
Keep me in temper; I would not be mad!"
-- King Lear
Madness in Civilization is simply one of the most stunning books I've ever read.
At various points in history, insanity, as depicted in Scull's book, has been deemed a divine punishment, a divine inspiration, a diabolical possession, an imbalance of humors, an honorable disease of the wealthy and super-intelligent, a hidden infection, a symptom of generational degeneracy, wartime "cowardice" deserving of sadistic punishment, a pitiful result of "refrigerator mothers," a chemical imbalance in the brain. Throughout history madness has most often been perceived, as it was by Lear, as a fate worse than death.
Nakedness and chains, humanity stripped of civilization and society's attempt to restrain the result, are recurring patterns, as are society's repeated oscillations between locking up the mad (often in deplorable conditions) and turning them loose in the community to fend for themselves. Those who feel for today's homeless mentally ill will feel sympathy for the 12th century madmen who were "left at large, 'free' to wander and to beg, at the mercy of a community that might respond with taunts and jeers, not to mention violence."
While mad relatives of the wealthy were hidden away in isolated, unregulated and often corrupt hospitals (compared to "tombs" for the living) to avoid family scandal, one didn't even need to be insane to be confined to a madhouse. Political opponents of powerful figures were shut up indefinitely in madhouses under "lettres de cachet," and women were often confined to madhouses or asylums for being sexual or inconvenient.
With the appearance of "terror neurosis" or "shell-shock" in WWI, doctors explored the link between traumatic experience and insanity that could produce physical symptoms such as paralysis or blindness. But, for the most part, mental illness remained inexplicable.
Unsurprisingly, Scull mentions the Nazi "T4" eugenics program to prevent "hereditarily diseased offspring," but, more surprisingly, he also mentions that as recently as the 1930s, the U.S. Supreme Court overwhelmingly (8-1) condoned the sterilization of the mentally ill against their will.
The discovery of syphilis, a biological disease, as a common cause of insanity, suggested that madness was rooted in the body, and doctors turned to biological cures. "Treatments" included insulin shock, electroshock and lobotomization. The more gentle "talking cure" of Freudian psychoanalysis gained popularity with celebrities and their followers, only to fall away as psychiatric drugs became readily available...and heavily promoted by drug companies to doctors. The publication of the Diagnostic Statistical Manual in 1952 attempted to standardize diagnosis criteria, and recommend particular drugs for their treatment.
One of the most enlightening, and disturbing, chapters focuses on the modern situation: "A Psychiatric Revolution?"
Many Americans, myself included, believe(d) that the mass discharge of the mentally ill into the community beginning in the mid-20th century was due to the emergence of effective psychotropic drugs. But Scull makes a convincing argument that the real reason was that the state hospitals were becoming too expensive for the states to maintain, and once some sort of medication (however effective or ineffective), in addition to federal support programs such as Supplemental Security Income, gave states a seemingly reasonable excuse to shut down their mental hospitals, they did, without regard for the fates of those cast out -- and who often ended up homeless or in prison.
An inquiry in the 1980s U.K. memorably determined that care for the mentally ill was "a poor relation: everybody's distant relative, but nobody's baby."
Scull is skeptical of the pharmaceutical industry and its claims of overwhelming success even as it overlooks numerous debilitating side effects and even heartbreaking failures such as increased suicides of adolescents and children prescribed Paxil and other SSRI drugs. He is particularly critical of DSM ties to pharmaceutical companies and of the recent "epidemics" of newly coined mental "illnesses" that were in the past considered merely elements of everyday life but now can be conveniently treated with newly discovered or adapted drugs. In cases of serious psychosis, the focus, Scull says, seems to be on ongoing symptom management rather than cure because "chronic conditions are chronically profitable."
He seems more condoning of psychoanalysis, without unnecessary supplementation with pharmaceuticals, and its consideration of the individual as a person with unique experiences and a place in society.
Madness is one of those brilliant books that lead the reader to seek out more. The bibliography is extensive, but readers will also be inspired to seek out the novels, paintings, plays, operas and films mentioned in the book. Hamlet and Ophelia, Lear and Macbeth get their due, as do Tess Durbeyfield, Esther Greenwood and the heroines of the skeptical Tennessee Williams (but noticeably not the characters of the hyper-Freudian Eugene O'Neill).
Although modern Far and Middle Eastern accounts of mental illness are noticeably absent, the work is an unusually compelling panorama of mental illness and its treatment in the Western world.
As far as nonfiction books go, I am generally a borrower, not a buyer. But I will buy this one.
On a side note, the cover design is one of the cleverest I've ever seen. A long string of text spirals into the center of the front cover, while the title on the spine seems to run out of room but keeps on going, and when it gets to the end, it goes "around the bend" (a euphemism for going insane).
Keep me in temper; I would not be mad!"
-- King Lear
Madness in Civilization is simply one of the most stunning books I've ever read.
At various points in history, insanity, as depicted in Scull's book, has been deemed a divine punishment, a divine inspiration, a diabolical possession, an imbalance of humors, an honorable disease of the wealthy and super-intelligent, a hidden infection, a symptom of generational degeneracy, wartime "cowardice" deserving of sadistic punishment, a pitiful result of "refrigerator mothers," a chemical imbalance in the brain. Throughout history madness has most often been perceived, as it was by Lear, as a fate worse than death.
Nakedness and chains, humanity stripped of civilization and society's attempt to restrain the result, are recurring patterns, as are society's repeated oscillations between locking up the mad (often in deplorable conditions) and turning them loose in the community to fend for themselves. Those who feel for today's homeless mentally ill will feel sympathy for the 12th century madmen who were "left at large, 'free' to wander and to beg, at the mercy of a community that might respond with taunts and jeers, not to mention violence."
While mad relatives of the wealthy were hidden away in isolated, unregulated and often corrupt hospitals (compared to "tombs" for the living) to avoid family scandal, one didn't even need to be insane to be confined to a madhouse. Political opponents of powerful figures were shut up indefinitely in madhouses under "lettres de cachet," and women were often confined to madhouses or asylums for being sexual or inconvenient.
With the appearance of "terror neurosis" or "shell-shock" in WWI, doctors explored the link between traumatic experience and insanity that could produce physical symptoms such as paralysis or blindness. But, for the most part, mental illness remained inexplicable.
Unsurprisingly, Scull mentions the Nazi "T4" eugenics program to prevent "hereditarily diseased offspring," but, more surprisingly, he also mentions that as recently as the 1930s, the U.S. Supreme Court overwhelmingly (8-1) condoned the sterilization of the mentally ill against their will.
The discovery of syphilis, a biological disease, as a common cause of insanity, suggested that madness was rooted in the body, and doctors turned to biological cures. "Treatments" included insulin shock, electroshock and lobotomization. The more gentle "talking cure" of Freudian psychoanalysis gained popularity with celebrities and their followers, only to fall away as psychiatric drugs became readily available...and heavily promoted by drug companies to doctors. The publication of the Diagnostic Statistical Manual in 1952 attempted to standardize diagnosis criteria, and recommend particular drugs for their treatment.
One of the most enlightening, and disturbing, chapters focuses on the modern situation: "A Psychiatric Revolution?"
Many Americans, myself included, believe(d) that the mass discharge of the mentally ill into the community beginning in the mid-20th century was due to the emergence of effective psychotropic drugs. But Scull makes a convincing argument that the real reason was that the state hospitals were becoming too expensive for the states to maintain, and once some sort of medication (however effective or ineffective), in addition to federal support programs such as Supplemental Security Income, gave states a seemingly reasonable excuse to shut down their mental hospitals, they did, without regard for the fates of those cast out -- and who often ended up homeless or in prison.
An inquiry in the 1980s U.K. memorably determined that care for the mentally ill was "a poor relation: everybody's distant relative, but nobody's baby."
Scull is skeptical of the pharmaceutical industry and its claims of overwhelming success even as it overlooks numerous debilitating side effects and even heartbreaking failures such as increased suicides of adolescents and children prescribed Paxil and other SSRI drugs. He is particularly critical of DSM ties to pharmaceutical companies and of the recent "epidemics" of newly coined mental "illnesses" that were in the past considered merely elements of everyday life but now can be conveniently treated with newly discovered or adapted drugs. In cases of serious psychosis, the focus, Scull says, seems to be on ongoing symptom management rather than cure because "chronic conditions are chronically profitable."
He seems more condoning of psychoanalysis, without unnecessary supplementation with pharmaceuticals, and its consideration of the individual as a person with unique experiences and a place in society.
Madness is one of those brilliant books that lead the reader to seek out more. The bibliography is extensive, but readers will also be inspired to seek out the novels, paintings, plays, operas and films mentioned in the book. Hamlet and Ophelia, Lear and Macbeth get their due, as do Tess Durbeyfield, Esther Greenwood and the heroines of the skeptical Tennessee Williams (but noticeably not the characters of the hyper-Freudian Eugene O'Neill).
Although modern Far and Middle Eastern accounts of mental illness are noticeably absent, the work is an unusually compelling panorama of mental illness and its treatment in the Western world.
As far as nonfiction books go, I am generally a borrower, not a buyer. But I will buy this one.
On a side note, the cover design is one of the cleverest I've ever seen. A long string of text spirals into the center of the front cover, while the title on the spine seems to run out of room but keeps on going, and when it gets to the end, it goes "around the bend" (a euphemism for going insane).
July 7, 2020
終於啃完這本正文將近五百頁的作品《瘋顛文明史（Madness in Civilization）》。本書並不難讀，主要是將人類文明（當然，還是以歐美為主）從古到今對於「瘋顛／精神病／思覺失調」的演進作一統籌性的論述。
本書最令我感到深刻的，是在 490 頁的一段話︰
「專家會告訴病人跟家屬，精神疾病的病因來自於大腦生化機制的問題，像是缺乏多巴胺或是血清素等等。但是這其實只是賣弄生物學術語來取代賣弄心理學術語，兩者誤導跟不科學的程度不分軒輊。其實，我們對大部分的精神疾病病因，仍然一無所知，但是賣弄這些生物學術語對於行銷藥物來說，倒是相當好用……」
在許多坊間的科普類的資訊中，我原本以為現代的生理科學已經對人體精神或情緒方面的研究有相當大的進展。但在本書出版的年代（2015年），作者 Andrew Scull 認為精神醫療界的能力，遠遠比不上其它現代醫學部門。也難怪本書在講述近代以來的瘋癲歷史時，「精神科」總是處於醫學界的最邊緣部門；換句話說，「瘋子醫生／精神科醫師／身心內科醫師」一向被圈內人所看不起，也難怪他們總是特別喜歡更改名稱術語。
這本《瘋顛文明史》提到了幾項社會在不同時代的發展特徵。在上古至中古年代，瘋顛被看成與神學有關的現像︰「中邪」——因此驅魔或宗教收容是治療的手段。到了近代醫學興起，瘋顛開始被視作一種「疾病」，脫離宗教、轉向世俗，而政府也逐漸認為這種「疾病」需要官方加以收容與管理——同時也有像法國薩德侯爵那種政府「逮捕令」的權力濫用的情況，同時也出現了許多令現代人覺得匪夷所思的可怕治療法（休克療法、腦葉切除）。本書也介紹了佛洛依德心理分析學派的興起與沒落。大戰結束以來，收容所關閉，腦精神生化機制理論興起，同時帶動了「藥物」市場的繁榮——作者對大藥廠過度強調新藥品的療效相當不以為然，多所批判。
雖然我不是醫療業界中人，但由我個人的某些經驗，曉得精神疾病這個領域，今天我們確實連其發生的機制、究竟要如何評量與確診、以及開發出來藥物功效，差不多都屬於瞎子摸象的階段。我十分認同作者的態度︰現代的精神科學的確一直有進展，但現代國際大藥廠所宣傳的神奇之處，大多都不可信。
值得一讀的好書。
本書最令我感到深刻的，是在 490 頁的一段話︰
「專家會告訴病人跟家屬，精神疾病的病因來自於大腦生化機制的問題，像是缺乏多巴胺或是血清素等等。但是這其實只是賣弄生物學術語來取代賣弄心理學術語，兩者誤導跟不科學的程度不分軒輊。其實，我們對大部分的精神疾病病因，仍然一無所知，但是賣弄這些生物學術語對於行銷藥物來說，倒是相當好用……」
在許多坊間的科普類的資訊中，我原本以為現代的生理科學已經對人體精神或情緒方面的研究有相當大的進展。但在本書出版的年代（2015年），作者 Andrew Scull 認為精神醫療界的能力，遠遠比不上其它現代醫學部門。也難怪本書在講述近代以來的瘋癲歷史時，「精神科」總是處於醫學界的最邊緣部門；換句話說，「瘋子醫生／精神科醫師／身心內科醫師」一向被圈內人所看不起，也難怪他們總是特別喜歡更改名稱術語。
這本《瘋顛文明史》提到了幾項社會在不同時代的發展特徵。在上古至中古年代，瘋顛被看成與神學有關的現像︰「中邪」——因此驅魔或宗教收容是治療的手段。到了近代醫學興起，瘋顛開始被視作一種「疾病」，脫離宗教、轉向世俗，而政府也逐漸認為這種「疾病」需要官方加以收容與管理——同時也有像法國薩德侯爵那種政府「逮捕令」的權力濫用的情況，同時也出現了許多令現代人覺得匪夷所思的可怕治療法（休克療法、腦葉切除）。本書也介紹了佛洛依德心理分析學派的興起與沒落。大戰結束以來，收容所關閉，腦精神生化機制理論興起，同時帶動了「藥物」市場的繁榮——作者對大藥廠過度強調新藥品的療效相當不以為然，多所批判。
雖然我不是醫療業界中人，但由我個人的某些經驗，曉得精神疾病這個領域，今天我們確實連其發生的機制、究竟要如何評量與確診、以及開發出來藥物功效，差不多都屬於瞎子摸象的階段。我十分認同作者的態度︰現代的精神科學的確一直有進展，但現代國際大藥廠所宣傳的神奇之處，大多都不可信。
值得一讀的好書。
March 19, 2017
Her psikoloji öğrencisinin kesinlikle okuması gereken bir kitap. Sadece deliliğin tarihini değil, psikiyatrinin, psikologların ve eleştirel psikolojinin ve deliliği iyileştirememenin tarihi aynı zamanda. Okurken sıklıkla yazarın araştırma becerilerine hayranlık duydum. Mükemmel.
February 11, 2018
Volumul lui Andrew Scull este o mostră de cultură autentică, de erudiție și enciclopedism, iar autorul trece prin toate etapele dezvoltării și evoluției umanității pentru a studia felul în care oamenii s-au raportat la nebunie, mai ales din perspectivă culturală, dar nu numai. Găsim aici atât studii medicale, psihologice sau de alte genuri ale personalului medical sau științific al fiecărei epoci, dar și felul în care anumite tare psihice sau fizice au fost transpuse în cultura epocii - sculptură, pictură, literatură, film, fotografie, desen.
O carte extrem de interesantă, bine documentată, pe care am citit-o în doze mici în ultimele luni.
O carte extrem de interesantă, bine documentată, pe care am citit-o în doze mici în ultimele luni.
August 7, 2015
I expected Madness in Civilization to be fascinating. A survey of the conception of insanity throughout the ages could hardly be anything but, and Scull's masterful (and thoroughly, gorgeously endnoted) research turns up gem after horrifying gem about the plight of the mad in society. (Fun fact: in the early 20th century, doctors tried treating insanity by infecting their patients with meningitis.)
What I did not expect was for Madness to be as lovely as it is, with its almost-Saul-Bass cover design, solid weight (I'm a sucker for good paperstock), and color plates, which make it a treat for the senses as well as the intellect.
Scull's writing style isn't up to the level of Andrew Solomon's or Kay Redfield Jamison's near-poetry, but his presentation is solid, clear, and well-paced. If I have any quibbles with his work at all, it's that I was deeply interested in the section on madness in the Ancient world, which -perhaps unsurprisingly - was the thinnest on actual historical information. Any disappointment I may have felt, however, was easily counteracted by the extreme awesome of his endnotes, which gave me enough suggested reading to keep me busy for the next few years.
Gorgeous and fascinating, Scull's Madness in Civilization is a treat for anyone interested in history, psychology, or the things people do to each other in the name of science and public safety.
What I did not expect was for Madness to be as lovely as it is, with its almost-Saul-Bass cover design, solid weight (I'm a sucker for good paperstock), and color plates, which make it a treat for the senses as well as the intellect.
Scull's writing style isn't up to the level of Andrew Solomon's or Kay Redfield Jamison's near-poetry, but his presentation is solid, clear, and well-paced. If I have any quibbles with his work at all, it's that I was deeply interested in the section on madness in the Ancient world, which -perhaps unsurprisingly - was the thinnest on actual historical information. Any disappointment I may have felt, however, was easily counteracted by the extreme awesome of his endnotes, which gave me enough suggested reading to keep me busy for the next few years.
Gorgeous and fascinating, Scull's Madness in Civilization is a treat for anyone interested in history, psychology, or the things people do to each other in the name of science and public safety.
June 26, 2023
O istorie culturală a nebuniei este exact ce promite. Expusă într-un ton profund didactic, fără intenția de a populariza știința în rândul celor care încă nu i-au văzut adevărata valoare, cartea se cere mai degrabă studiată, nu citită de cineva care pur și simplu vrea să își dezvolte cultura generală. Eu am citit-o pe parcursul unei luni, rar și în doze mici, pentru că mi s-a părut prea aglomerată cu informații mărunte. O lectură interesantă, dar și obositoare. Recenzia aici: https://shorturl.at/bgjQZ.
,,Durerea și suferința pe care pierderea rațiunii le aduce victimelor sale, apropiaților acestora și societății în general sunt lucruri pe care niciun om care întâlnește acest subiect nu poate sau nu ar trebui să le ignore ori să le minimalizeze. Aici se găsesc cele mai profunde forme ale suferinței omenești - tristețe, izolare, alienare, suferință și moartea rațiunii și a conștiinței.''
,,Durerea și suferința pe care pierderea rațiunii le aduce victimelor sale, apropiaților acestora și societății în general sunt lucruri pe care niciun om care întâlnește acest subiect nu poate sau nu ar trebui să le ignore ori să le minimalizeze. Aici se găsesc cele mai profunde forme ale suferinței omenești - tristețe, izolare, alienare, suferință și moartea rațiunii și a conștiinței.''
June 17, 2015
This book is a very good read, although the topic and size of it may not at first compel you to pick it up. Scull is an expert in what is know about madness throughout history. He starts by going through the earliest written record of mad people, right up to modern day definitions and practises.
The book is full of fascinating stories of people and doctors who developed psychiatry. Treatments vary from the sadistic to the ingenious and are an eye opener to the medical profession.
I thoroughly enjoyed learning about this field, madness is a fascinating topic. Even now, it seems no one can define madness. Well worth reading by lay people, Scull has a very approachable writing style and can tell a good story.
The book is full of fascinating stories of people and doctors who developed psychiatry. Treatments vary from the sadistic to the ingenious and are an eye opener to the medical profession.
I thoroughly enjoyed learning about this field, madness is a fascinating topic. Even now, it seems no one can define madness. Well worth reading by lay people, Scull has a very approachable writing style and can tell a good story.
February 6, 2020
Áttekintő monográfia az őrületről, illetve arról, ahogy a társadalom saját őrültjeihez viszonyul. Megjegyzem, ez a viszonyulás talán tekinthető a mindenkori civilizációk lakmuszpapírjának is – hogy a társadalom azokat, akiket nem képes szabályszerűen integrálni magába, hogyan kezeli. Nos, diadalmenetre ne számítsunk. Ami azt illeti, Scull megközelítésében épp az volt számomra a legfeltűnőbb, mennyire pesszimistán látja ezt az egész folyamatot. Kezdjük azzal, sokáig meg sem fordult ennek a híres-neves civilizációnak a fejében, hogy ezeken az embereken segíteni is lehetne: valami isteni vagy démoni megszállottságnak tartották állapotukat, ami ha túlságosan zavaróvá válik, akkor hordozóját oda kell láncolni valami pincében a falhoz, oszt jónapot. És ez még a jobbik eset – már ha jobbik eset, ízlés dolga –, mert a másik opció, hogy boszorkánynak kiáltották ki, és a mai szabadtéri fesztiválokra – lacikonyha plusz besörözött férfiak – emlékeztető körülmények között máglyára vetették őket.
Aztán később felmerült a gondolat, hogy valami konstruktívat is lehetne csinálni szerencsétlenekkel, de alkalmasint ez sem vezetett olyan hű-de-nagy fejlődéshez. Megkezdődött ugyan a „bolondházak” létesítése a XVII. század végén, de tapsikolni korai volna, mert ezek a létesítmények is leginkább valami Bosch-féle pokolábrázolásra emlékeztettek, ahol a kezelés kimerült abban, hogy a kuncsaftokat addig ütlegelték, amíg azok megtanulták nyugodtnak tettetni magukat. Mindenesetre ekkorra legalább elkezdtek gondolkodni azon, miképp lehetne változást előidézni az elmebetegek állapotában, és ezt még akkor is kénytelenek vagyunk értékelni, ha a változtatás mai szemmel kimeríti a súlyos testi sértés (sőt: a gyilkossági kísérlet) fogalmát. És elkezdték mélyebben vizsgálni a mentális betegségek okait is – ám, ami azt illeti, nem nagyon jutottak sokra. A számos elmélet közül akadt olyan, ami a betegséget a civilizációs változások következményének, egyfajta „túlfinomodásnak" (lásd a híres brit spleen) tekintette, mások pedig szervi okokat kutattak-kerestek (például Gall a maga idejében elképzelhetetlenül népszerű elmélete: https://hu.wikipedia.org/wiki/Frenol%...), némelyiket közülük bízvást nevezhetnénk mókásnak, ha nem tudnánk, hogy itt bizony életekről volt szó. Az pedig, hogy az elmekórtan puha, bizonytalan körvonalú tudomány maradt, tökéletes terepet teremtett a sarlatánok számára, akiket Scull méla megvetéssel kezel, de ne feledjük, akadnak náluk is rosszabbak, jelesül a hentesek. Például Henry Cotton, aki valamiért úgy vélte, hogy a betegek beleiből és gyomrából darabokat kivágni marha jó ötlet. Az a 30-45%-os halálozási arány a műtétek során meg nyilván szóra sem érdemes malőr.
Ezek után kész felüdülés Freud megjelenése. Persze, persze, az öreg egy igazi kis diktátor volt, aki finoman meghamisította a kutatási eredményeket is, és nem feltétlenül gondolom azt sem, hogy jelenkori (és fenemód jól titkolt) frusztrációim mind abból fakadnak, hogy szerelmes voltam édesanyámba, ezzel összefüggésben pedig édesapámat meg el akartam pusztítani. (De komolyan nem, apu. Becsszó.) Az is lehetséges, hogy a pszichoanalitikusok díványa igazi pénznyelő volt, ami (különösen Ámerikában) más célt se szolgált, mint hogy eret vágjanak a gazdagok bankszámláján. Ugyanakkor ő legalább nem akart a betegek agyába egy jégcsákányt beleverni*. Freud volt az első az elmekórtan történetében, aki úgy kívánt foglalkozni a mentális betegségekkel, hogy magával a beteggel is kommunikálni próbált – ez azért véleményem szerint olyan forradalmi fejlődés, amit a szerző akár jobban is kihangsúlyozhatott volna.
Scull a végén aztán a jelenkori stratégiákról is ejt pár szót, a „gyógyszerforradalomról”, a pszichotrop szerek számának ugrásszerű megnövekedéséről, ami gyökeresen átalakította az őrület kezelésének módját – de aki szerint ez a happy end, azt ki kell ábrándítsam, mert a szerző ebben is megtalálja a negatívumokat, mégpedig vastagon, és tegyük hozzá, joggal. Szóval nem is vetném a könyv szemére, hogy nem láttatja velem a fényt az alagút végén, de azért… csendben, halkan mondom… szóval valami reménysugár, valami alternatíva, valami vállalható cselekvési út jót tett volna az én kis érzékeny lelkemnek.
* Gondolom, mindenkinek megvan a Száll a kakukk fészkére, ami egy komplett generáció agyában kialakította a viszonyulást a lobotómia gyakorlatával szemben. Ha meg valakinek nincs meg – hát bocs a spoilerezésért. De említhetnénk JFK húgának, Rosemary Kennedynek az esetét is, akit hangulatváltozásai (!) és férfiak iránt tanúsított érdeklődése (!!!) miatt vetettek alá az eljárásnak, és naná, hogy emberi roncsot csináltak belőle. És ha valakinek ezek után nincs tele a szája keserű nyállal, hát megemlíteném, hogy 1949-ben egy bizonyos António Egas Moniz Nobel-díjat is kapott a lobotómia terén elért eredményeiért.
Aztán később felmerült a gondolat, hogy valami konstruktívat is lehetne csinálni szerencsétlenekkel, de alkalmasint ez sem vezetett olyan hű-de-nagy fejlődéshez. Megkezdődött ugyan a „bolondházak” létesítése a XVII. század végén, de tapsikolni korai volna, mert ezek a létesítmények is leginkább valami Bosch-féle pokolábrázolásra emlékeztettek, ahol a kezelés kimerült abban, hogy a kuncsaftokat addig ütlegelték, amíg azok megtanulták nyugodtnak tettetni magukat. Mindenesetre ekkorra legalább elkezdtek gondolkodni azon, miképp lehetne változást előidézni az elmebetegek állapotában, és ezt még akkor is kénytelenek vagyunk értékelni, ha a változtatás mai szemmel kimeríti a súlyos testi sértés (sőt: a gyilkossági kísérlet) fogalmát. És elkezdték mélyebben vizsgálni a mentális betegségek okait is – ám, ami azt illeti, nem nagyon jutottak sokra. A számos elmélet közül akadt olyan, ami a betegséget a civilizációs változások következményének, egyfajta „túlfinomodásnak" (lásd a híres brit spleen) tekintette, mások pedig szervi okokat kutattak-kerestek (például Gall a maga idejében elképzelhetetlenül népszerű elmélete: https://hu.wikipedia.org/wiki/Frenol%...), némelyiket közülük bízvást nevezhetnénk mókásnak, ha nem tudnánk, hogy itt bizony életekről volt szó. Az pedig, hogy az elmekórtan puha, bizonytalan körvonalú tudomány maradt, tökéletes terepet teremtett a sarlatánok számára, akiket Scull méla megvetéssel kezel, de ne feledjük, akadnak náluk is rosszabbak, jelesül a hentesek. Például Henry Cotton, aki valamiért úgy vélte, hogy a betegek beleiből és gyomrából darabokat kivágni marha jó ötlet. Az a 30-45%-os halálozási arány a műtétek során meg nyilván szóra sem érdemes malőr.
Ezek után kész felüdülés Freud megjelenése. Persze, persze, az öreg egy igazi kis diktátor volt, aki finoman meghamisította a kutatási eredményeket is, és nem feltétlenül gondolom azt sem, hogy jelenkori (és fenemód jól titkolt) frusztrációim mind abból fakadnak, hogy szerelmes voltam édesanyámba, ezzel összefüggésben pedig édesapámat meg el akartam pusztítani. (De komolyan nem, apu. Becsszó.) Az is lehetséges, hogy a pszichoanalitikusok díványa igazi pénznyelő volt, ami (különösen Ámerikában) más célt se szolgált, mint hogy eret vágjanak a gazdagok bankszámláján. Ugyanakkor ő legalább nem akart a betegek agyába egy jégcsákányt beleverni*. Freud volt az első az elmekórtan történetében, aki úgy kívánt foglalkozni a mentális betegségekkel, hogy magával a beteggel is kommunikálni próbált – ez azért véleményem szerint olyan forradalmi fejlődés, amit a szerző akár jobban is kihangsúlyozhatott volna.
Scull a végén aztán a jelenkori stratégiákról is ejt pár szót, a „gyógyszerforradalomról”, a pszichotrop szerek számának ugrásszerű megnövekedéséről, ami gyökeresen átalakította az őrület kezelésének módját – de aki szerint ez a happy end, azt ki kell ábrándítsam, mert a szerző ebben is megtalálja a negatívumokat, mégpedig vastagon, és tegyük hozzá, joggal. Szóval nem is vetném a könyv szemére, hogy nem láttatja velem a fényt az alagút végén, de azért… csendben, halkan mondom… szóval valami reménysugár, valami alternatíva, valami vállalható cselekvési út jót tett volna az én kis érzékeny lelkemnek.
* Gondolom, mindenkinek megvan a Száll a kakukk fészkére, ami egy komplett generáció agyában kialakította a viszonyulást a lobotómia gyakorlatával szemben. Ha meg valakinek nincs meg – hát bocs a spoilerezésért. De említhetnénk JFK húgának, Rosemary Kennedynek az esetét is, akit hangulatváltozásai (!) és férfiak iránt tanúsított érdeklődése (!!!) miatt vetettek alá az eljárásnak, és naná, hogy emberi roncsot csináltak belőle. És ha valakinek ezek után nincs tele a szája keserű nyállal, hát megemlíteném, hogy 1949-ben egy bizonyos António Egas Moniz Nobel-díjat is kapott a lobotómia terén elért eredményeiért.
September 1, 2015
This broad history of attitudes toward and treatment of mental illness got off to a slow start for me. Knowing the library would demand it back, I skipped through the early part of the book where treatment focused on how to exorcise demons. Later chapters were more interesting to me. Mental illness encompasses many different diseases, some of which are cyclical. Many different treatments have appeared to work, especially when advocated by a charismatic practitioner. Hypnotism, psychoanalysis, surgery, drugs and more have all at some point seemed to be The Solution. While genuine progress has been made in treating some types of mental illness, treatments and society's view of insanity continue to change.
March 12, 2023
Disturbing! A well done cultural history of psychiatry and mental healthcare that was haunting, disappointing, and constructive all at once.
July 10, 2019
В культовом мультсериале «Дарья» одними из моих любимых моментов были короткие рекламные зарисовки программы «Больной безумный мир». Скалл с тем же приглушенным цинизмом смотрит на историю стигмы больного и безумного мира от Библии до современных препаратов в Madness in Civilization.
В отличие от большинства авторов, искренне увлеченных патологиями Другого, Скалл уделяет большее внимание не расстройствам и пациентам, а людям и институтам вокруг них. Безумие — абстракция с размытыми контурами, и история излечения полна ошибок, невежества, спекуляций и алчности. От "престижных" британских неврозов он ведет читателя к далеким от медицины спектаклям Франца Месмера, в которых позы из Jojo's Bizarre Adventure смешались с возложением рук, от темниц, куда мужья упекали своих неугодных жен — к экскурсиям в Бедлам. Кто здесь действительно безумен: пациент, осознавший проблему, врач-шарлатан, доверчивые обыватели? В книге этот вопрос возникает вновь и вновь. Безумные и незащищенные постоянно становились ресурсом или просто нежеланным объектом для богатых и обладающих властью садистов. На них зарабатывали, о них писал Шекспир, их рисовал Хогарт. Скалл не смакует страдания и не поднимает больных на знамя, что спасает текст от популистского привкуса, но посыл остается понятен.
Он также не углубляется в фармакологическую терминологию, но объясняет сложные вещи понятным языком и рассказывает историю этой области медицины через истории ее героев, переходя с ними из главы в главу, из эпохи в эпоху. Здесь намного больше глобальных процессов и культуры, чем медицины, но это необходимые для понимания всей сложности феномена безумия стороны социальной жизни. К концу книги взгляд Скалла обретает для читателя завершенные формы: медицинские институты — кузницы безумия, подлинное искусство — для утешения беспокойных и сомнения беззаботных, безумец — человек, для которого всегда можно найти место в мире.
Обязательная книга для интересующихся. Очень плотный текст без филлеров и топтания на месте.
В отличие от большинства авторов, искренне увлеченных патологиями Другого, Скалл уделяет большее внимание не расстройствам и пациентам, а людям и институтам вокруг них. Безумие — абстракция с размытыми контурами, и история излечения полна ошибок, невежества, спекуляций и алчности. От "престижных" британских неврозов он ведет читателя к далеким от медицины спектаклям Франца Месмера, в которых позы из Jojo's Bizarre Adventure смешались с возложением рук, от темниц, куда мужья упекали своих неугодных жен — к экскурсиям в Бедлам. Кто здесь действительно безумен: пациент, осознавший проблему, врач-шарлатан, доверчивые обыватели? В книге этот вопрос возникает вновь и вновь. Безумные и незащищенные постоянно становились ресурсом или просто нежеланным объектом для богатых и обладающих властью садистов. На них зарабатывали, о них писал Шекспир, их рисовал Хогарт. Скалл не смакует страдания и не поднимает больных на знамя, что спасает текст от популистского привкуса, но посыл остается понятен.
Он также не углубляется в фармакологическую терминологию, но объясняет сложные вещи понятным языком и рассказывает историю этой области медицины через истории ее героев, переходя с ними из главы в главу, из эпохи в эпоху. Здесь намного больше глобальных процессов и культуры, чем медицины, но это необходимые для понимания всей сложности феномена безумия стороны социальной жизни. К концу книги взгляд Скалла обретает для читателя завершенные формы: медицинские институты — кузницы безумия, подлинное искусство — для утешения беспокойных и сомнения беззаботных, безумец — человек, для которого всегда можно найти место в мире.
Обязательная книга для интересующихся. Очень плотный текст без филлеров и топтания на месте.
January 30, 2022
Harika bir kitap.
Deliliğin uygarlığın dışında, kıyısında-köşesinde yer almak şöyle dursun, uygarlığın tam merkezinde, uygarlıkla birlikte gelişip şekillendiğini, deliliğin uygarlığın kalıcı bir parçası olduğunu gösteriyor. Bir yandan da delilikle başa çıkmanın ne kadar meşakkatli olduğunu ve henüz sırrının çözülmesinin mümkün olmadığını...
Kutsal metinlerden başlayarak modern bilimin, psikiyatrinin, nörolojinin gelişimine, Freud ve sonrasına,.... insanlığın delilik muamması ile mücadelesinin öyküsünü anlatıyor. Tarih boyunca akıl hastalarına yapılan "insan aklını zorlayan" muamelelerden, tedavi yöntemlerinden, akıl hastanelerinin, tımarhanelerin oluşumu, modern tıbbın hakim olduğu günümüz dünyasına evrimi, gelişimi ele alınmış.
Kitap boyunca deliliğe yaklaşım ve tedavi yöntemleri ile beraber insan algısının, kültürün, uygarlığın gelişimini de okuma imkanınız oluyor. Ayrıca deliliğin resim, sinema, müzik gibi sanat dallarına etkisi de örneklerle irdeleniyor.
Kitabın sonuçta vardığı tez; Ne kadar uzun yol kat etmiş olsak ta deliliğin içinde yaşadığımız modern tıp dünyasında henüz açıklanabilmekten çok uzak olduğu... Ancak; deliliğin biyolojik indirgemeciler gibi sadece nöroloji ve beynin bir kusuru olarak görerek ilerlememizin mümkün olmadığını, çünkü beynin bizzat yapısı ve işleyişinin sosyal ortamın dolayısıyla uygarlığın bir ürünü olduğunun altını çiziyor. Deliliğin köklerinin sadece beynimizin biyolojik yapısında arama hatasına düşmememiz gerektiğini, ayrıca beynimizin dışında sosyal ortamda, toplum yapısında aramamız gerektiğini çünkü beynin ve dolayısıyla deliliğin bu ikisinin etkileşimi ile gelişip şekillendiğini, deliliğin uygarlığın gelişiminden bağımsız olarak çözümlenemeyeceğinin altını çiziyor.
Tavsiye ederim.
Deliliğin uygarlığın dışında, kıyısında-köşesinde yer almak şöyle dursun, uygarlığın tam merkezinde, uygarlıkla birlikte gelişip şekillendiğini, deliliğin uygarlığın kalıcı bir parçası olduğunu gösteriyor. Bir yandan da delilikle başa çıkmanın ne kadar meşakkatli olduğunu ve henüz sırrının çözülmesinin mümkün olmadığını...
Kutsal metinlerden başlayarak modern bilimin, psikiyatrinin, nörolojinin gelişimine, Freud ve sonrasına,.... insanlığın delilik muamması ile mücadelesinin öyküsünü anlatıyor. Tarih boyunca akıl hastalarına yapılan "insan aklını zorlayan" muamelelerden, tedavi yöntemlerinden, akıl hastanelerinin, tımarhanelerin oluşumu, modern tıbbın hakim olduğu günümüz dünyasına evrimi, gelişimi ele alınmış.
Kitap boyunca deliliğe yaklaşım ve tedavi yöntemleri ile beraber insan algısının, kültürün, uygarlığın gelişimini de okuma imkanınız oluyor. Ayrıca deliliğin resim, sinema, müzik gibi sanat dallarına etkisi de örneklerle irdeleniyor.
Kitabın sonuçta vardığı tez; Ne kadar uzun yol kat etmiş olsak ta deliliğin içinde yaşadığımız modern tıp dünyasında henüz açıklanabilmekten çok uzak olduğu... Ancak; deliliğin biyolojik indirgemeciler gibi sadece nöroloji ve beynin bir kusuru olarak görerek ilerlememizin mümkün olmadığını, çünkü beynin bizzat yapısı ve işleyişinin sosyal ortamın dolayısıyla uygarlığın bir ürünü olduğunun altını çiziyor. Deliliğin köklerinin sadece beynimizin biyolojik yapısında arama hatasına düşmememiz gerektiğini, ayrıca beynimizin dışında sosyal ortamda, toplum yapısında aramamız gerektiğini çünkü beynin ve dolayısıyla deliliğin bu ikisinin etkileşimi ile gelişip şekillendiğini, deliliğin uygarlığın gelişiminden bağımsız olarak çözümlenemeyeceğinin altını çiziyor.
Tavsiye ederim.
September 11, 2020
This book would be more accurately subtitled as a cultural history of WHITE insanity. Scull takes a very euro-American-centric approach to exploring the history of mental illness. The complete lack of BIPOC representation/consideration speaks to what is missing from this exploration of mental illness. I’m giving it two stars because he raises quite a few interesting points. However, his lack of representation made this a frustrating read.
July 7, 2019
http://bit.ly/ludiloucivilizaciji
„Biti lud znači biti besposlen, ili barem općenito nesposoban za produktivan rad.“
Znate ono, bude vam nešto, dođete u bolnicu, izliječite se i liječnik vam kaže, aj bok, ne vidimo se više nikad? Karikiram, ali znate na što mislim. Postoje bolesti iz gotovo svake grane medicine koje su u potpunosti izlječive. Dakle, izliječiš bolest i kažeš joj zbogom za zauvijek. Ubijte me, ne mogu se ovog trena sjetiti nijedne. U psihijatriji to nije tako. Bolest se liječi i dovodi se u normalu, ali nema nijedne kojoj ćete reći zbogom za zauvijek.
Iako smo u dobu brzog napretka u gotovo svim područjima, psihijatrija nam je još uvijek veliko i neistraženo područje. Imajte na umu da ću o ovoj temi diskutirati isključivo kao laik, jer nemam iskustva sa radom na psihijatriji, to je samo moja velika želja.
Mojoj zainteresiranosti za psihijatriju doskočio je Sandorf, poslavši mi knjigu Ludilo u civilizaciji, koja je u meni izazvala lavinu podijeljenih osjećaja. Krenuvši od početka svijeta, Andrew Scull nam je na izrazito slikovit način pokazao kako se definicija ludila kretala do danas.
„Medicina je znanost po kojoj učimo o stanju ljudskog tijela u zdravlju i u odsutnosti zdravlja kako bismo zdravlje održali ili ga vratili.“
Od početka svijeta, ljudi su liječili. Liječili su osipe, glavobolje, rane, opekline. Ponekad molitvama, žrtvovanjem, biljkama. Proučavali su ljudsko tijelo i donosili zaključke o bolestima. U početku, ako si bio bolestan, to je bila kazna. Nešto si krivo napravio.
„U ovom svijetu bolest je jedan od Božjih kazna za grešnike, muka koju su zaslužili i upozorenje na ono što bi ih lako moglo čekati na onom svijetu.“
Od velikog grčkog do rimskog carstva, ljudi su imali sustav vjerovanja. Bogove koji su gledale male ljude i nagrađivali ih po zaslugama. Kažnjavali po zaslugama. Bogovi su se miješali u živote ljudi. Oni su bili njihova puka igračka. Zašto onda ne začiniti svijet s ludilom?
I tu su nastale prve dvojbe. Polazi li ludilo iz nekog oblika patologije ili od bogova? Da li je ludilo bolest tijela ako ne možemo sa sigurnošću reći odakle kreće? „Čak ni liječnici, nepopravljivo skloni organičkim tumačenjima mentalnih poremećaja, katkad nisu mogli izbjeći da priznaju kako je ludilo društveno definirano i kako je više od puko tjelesnog stanja.“
Očito je bilo da ljudi koji su imali ludilo da imaju problem s mozgom. No kakav točno? Mozak je bio iste veličine, iste teksture kao u „normalnog“ čovjeka. Što je zapravo bio uzrok ludila? „Ludilo, činilo se, bez obzira na stručnjake, nije nešto što se može izliječiti moralnom skrbi (pa čak ni promišljenim spajanjem moralne i medicinske skrbi), nego je prije porazna, okrutna doživotna kazna.“
Učili smo kako su se ljudi prije ponašali prema onima koji su imali ludilo. „I uistinu, za liječenje lude čeljadi nema ničega učinkovitijeg ni potrebnijeg no što je njihovo strahopoštovanje spram onih koje smatraju svojim mučiteljima. Mahniti luđaci skorije će se i sigurnije izliječiti kaznama i oštrim postupanjem u zatvoreničkoj ćeliji nego medicinom i lijekovima.“ Thomas Willis, 17.st.
Izolacija, zatvaranje, postupanje u nehumanim uvjetima. Neprijateljstvo. Ono što je mene najviše iznenadilo je činjenica da su se lobotomije izvodile krajem 19., početkom 20. stoljeća. Ne tako davno, zar ne?
No, što danas imamo? Danas imamo humanu fiksaciju. Vežemo ljude za njihovo dobro. Ili za naše? Nismo okrutni prema psihijatrijskim bolesnicima. Barem ne fizički. Većinom su mirni, uz odgovarajući koktel lijekova. „Sam identitet psihijatrije danas je usko skopčan s njenim monopolom na propisivanje lijekova, a u rukama psihijatara tablete su zamijenile razgovor kao glavnu reakciju na poremećaje rasuđivanja, osjećaja i ponašanja. Bolesnici i njihove obitelji sada očekuju da im njihovi liječnici daju čarobne napitke od kojih će posredstvom kemije bolje živjeti.“
I tko su zapravo psihijatri? Što su oni naučili? Jesu li nešto naučili? Mogu li nešto sa sigurnošću tvrditi? Povijest nas je naučila kako je mentalna bolest još uvijek velika stigma. Bez obzira na otvorenost i tolerantnost društva, psihijatrijski bolesnici još uvijek nose veliko breme stigme. Društvo ih ostavlja na marginama, obitelj ne zna kako bi se s njima nosila, pa čak i zdravstveno osoblje mahom bježi od njih (pogotovo oni koji ne rade na odjelu psihijatrije). Na koncu, kako oni mogu imati bilo kakvu šansu za uspješan oporavak ukoliko društvo ne zna kako im pristupiti i kako se s njima nositi?
Iskreno vjerujem kako je psihijatrija doživjela napredak. No, kakav napredak? Znamo li sa sigurnošću što uopće radimo i postupamo li na ispravan način? Imamo ljude koji se po normama normalnog ljudskog ponašanja ne uklapaju. S kojima nešto psihički nije u redu. Imamo li dovoljno znanja i dovoljno predanosti kako bi mogli postupati s njima? Ili smo svi u obrambenom stavu kako su oni potencijalna prijetnja društvu, te tu prijetnju moramo spriječiti kako znamo i umijemo? „Napokon, usprkos obilju tvrdnji da je uzrok mentalne bolesti u manjkavoj biokemiji mozga, u manjku ili višku ovog ili onog neurotransmitera, da je proizvod genetike i da će se jednog dana možda dovesti u vezu s biološkim markerima, etiologija većine mentalnih bolesti ostaje nejasna, a njihovo liječenje mahom je simptomatsko i dvojbene učinkovitosti.“
„Autoritet i red, moraju se, doduše, održavati, ali ih je bolje održavati ljubaznošću, milostivošću i obzirnom pažnjom, a ne bilo kakvim strogostima. Sumanuti nisu lišeni razuma, niti bi prema njima trebalo postupati kao da jesu; naprotiv, prema njima treba postupati kao prema razumnim bićima.“ Thomas Bakewell, 19.st
No, postupamo li i danas prema njima tako? Rekla bih da smo napredovali, ne činimo im fizički zlo. Psihički? Nisam baš sigurna. Živimo u svijetu okrutnih riječi, koje mogu napraviti više štete nego udarac. Želimo da ljudi dobiju potrebnu skrb, ali daleko od naših očiju. O svim bolestima pričamo normalno, ali kada je riječ o mentalnim bolestima, spuštamo glas. Ne želimo da to itko čuje. Imati mentalnu bolest još uvijek je neki oblik sramote. „Evo klasičnih stereotipa o ludilu – asocijalnost, otuđenost od stvarnosti i normi konvencionalnog morala, svedenost na razinu životinje, zastrašujuće otpadništvo, nepredvidljivost – a njegova je žrtva u mnogim verzijama priče opsjednuta zloćudnim džinom.“
S namjerom sam se otuđila o knjige, jer volim pričati o problematici psihijatrije. Ova knjiga mi je bila samo paravan. Šalim se. Ludilo u civilizaciji je iznimno pitka i zanimljiva knjiga u kojoj možete kronološki pratiti što se događalo na putu od ludila do psihijatrije kakvu poznajemo danas.
Ne bojte se, ne morate imati diplomu iz područja medicinskih znanosti da bi razumjeli knjigu. Morate samo imati interes. Vjerujte mi, ovo želite pročitati.
Andrew Scull nam piše o tome koliko smo napredovali kao društvo u pogledu ludila. Jesmo li? Presudite sami.
Grickajmo knjige zajedno!
„Biti lud znači biti besposlen, ili barem općenito nesposoban za produktivan rad.“
Znate ono, bude vam nešto, dođete u bolnicu, izliječite se i liječnik vam kaže, aj bok, ne vidimo se više nikad? Karikiram, ali znate na što mislim. Postoje bolesti iz gotovo svake grane medicine koje su u potpunosti izlječive. Dakle, izliječiš bolest i kažeš joj zbogom za zauvijek. Ubijte me, ne mogu se ovog trena sjetiti nijedne. U psihijatriji to nije tako. Bolest se liječi i dovodi se u normalu, ali nema nijedne kojoj ćete reći zbogom za zauvijek.
Iako smo u dobu brzog napretka u gotovo svim područjima, psihijatrija nam je još uvijek veliko i neistraženo područje. Imajte na umu da ću o ovoj temi diskutirati isključivo kao laik, jer nemam iskustva sa radom na psihijatriji, to je samo moja velika želja.
Mojoj zainteresiranosti za psihijatriju doskočio je Sandorf, poslavši mi knjigu Ludilo u civilizaciji, koja je u meni izazvala lavinu podijeljenih osjećaja. Krenuvši od početka svijeta, Andrew Scull nam je na izrazito slikovit način pokazao kako se definicija ludila kretala do danas.
„Medicina je znanost po kojoj učimo o stanju ljudskog tijela u zdravlju i u odsutnosti zdravlja kako bismo zdravlje održali ili ga vratili.“
Od početka svijeta, ljudi su liječili. Liječili su osipe, glavobolje, rane, opekline. Ponekad molitvama, žrtvovanjem, biljkama. Proučavali su ljudsko tijelo i donosili zaključke o bolestima. U početku, ako si bio bolestan, to je bila kazna. Nešto si krivo napravio.
„U ovom svijetu bolest je jedan od Božjih kazna za grešnike, muka koju su zaslužili i upozorenje na ono što bi ih lako moglo čekati na onom svijetu.“
Od velikog grčkog do rimskog carstva, ljudi su imali sustav vjerovanja. Bogove koji su gledale male ljude i nagrađivali ih po zaslugama. Kažnjavali po zaslugama. Bogovi su se miješali u živote ljudi. Oni su bili njihova puka igračka. Zašto onda ne začiniti svijet s ludilom?
I tu su nastale prve dvojbe. Polazi li ludilo iz nekog oblika patologije ili od bogova? Da li je ludilo bolest tijela ako ne možemo sa sigurnošću reći odakle kreće? „Čak ni liječnici, nepopravljivo skloni organičkim tumačenjima mentalnih poremećaja, katkad nisu mogli izbjeći da priznaju kako je ludilo društveno definirano i kako je više od puko tjelesnog stanja.“
Očito je bilo da ljudi koji su imali ludilo da imaju problem s mozgom. No kakav točno? Mozak je bio iste veličine, iste teksture kao u „normalnog“ čovjeka. Što je zapravo bio uzrok ludila? „Ludilo, činilo se, bez obzira na stručnjake, nije nešto što se može izliječiti moralnom skrbi (pa čak ni promišljenim spajanjem moralne i medicinske skrbi), nego je prije porazna, okrutna doživotna kazna.“
Učili smo kako su se ljudi prije ponašali prema onima koji su imali ludilo. „I uistinu, za liječenje lude čeljadi nema ničega učinkovitijeg ni potrebnijeg no što je njihovo strahopoštovanje spram onih koje smatraju svojim mučiteljima. Mahniti luđaci skorije će se i sigurnije izliječiti kaznama i oštrim postupanjem u zatvoreničkoj ćeliji nego medicinom i lijekovima.“ Thomas Willis, 17.st.
Izolacija, zatvaranje, postupanje u nehumanim uvjetima. Neprijateljstvo. Ono što je mene najviše iznenadilo je činjenica da su se lobotomije izvodile krajem 19., početkom 20. stoljeća. Ne tako davno, zar ne?
No, što danas imamo? Danas imamo humanu fiksaciju. Vežemo ljude za njihovo dobro. Ili za naše? Nismo okrutni prema psihijatrijskim bolesnicima. Barem ne fizički. Većinom su mirni, uz odgovarajući koktel lijekova. „Sam identitet psihijatrije danas je usko skopčan s njenim monopolom na propisivanje lijekova, a u rukama psihijatara tablete su zamijenile razgovor kao glavnu reakciju na poremećaje rasuđivanja, osjećaja i ponašanja. Bolesnici i njihove obitelji sada očekuju da im njihovi liječnici daju čarobne napitke od kojih će posredstvom kemije bolje živjeti.“
I tko su zapravo psihijatri? Što su oni naučili? Jesu li nešto naučili? Mogu li nešto sa sigurnošću tvrditi? Povijest nas je naučila kako je mentalna bolest još uvijek velika stigma. Bez obzira na otvorenost i tolerantnost društva, psihijatrijski bolesnici još uvijek nose veliko breme stigme. Društvo ih ostavlja na marginama, obitelj ne zna kako bi se s njima nosila, pa čak i zdravstveno osoblje mahom bježi od njih (pogotovo oni koji ne rade na odjelu psihijatrije). Na koncu, kako oni mogu imati bilo kakvu šansu za uspješan oporavak ukoliko društvo ne zna kako im pristupiti i kako se s njima nositi?
Iskreno vjerujem kako je psihijatrija doživjela napredak. No, kakav napredak? Znamo li sa sigurnošću što uopće radimo i postupamo li na ispravan način? Imamo ljude koji se po normama normalnog ljudskog ponašanja ne uklapaju. S kojima nešto psihički nije u redu. Imamo li dovoljno znanja i dovoljno predanosti kako bi mogli postupati s njima? Ili smo svi u obrambenom stavu kako su oni potencijalna prijetnja društvu, te tu prijetnju moramo spriječiti kako znamo i umijemo? „Napokon, usprkos obilju tvrdnji da je uzrok mentalne bolesti u manjkavoj biokemiji mozga, u manjku ili višku ovog ili onog neurotransmitera, da je proizvod genetike i da će se jednog dana možda dovesti u vezu s biološkim markerima, etiologija većine mentalnih bolesti ostaje nejasna, a njihovo liječenje mahom je simptomatsko i dvojbene učinkovitosti.“
„Autoritet i red, moraju se, doduše, održavati, ali ih je bolje održavati ljubaznošću, milostivošću i obzirnom pažnjom, a ne bilo kakvim strogostima. Sumanuti nisu lišeni razuma, niti bi prema njima trebalo postupati kao da jesu; naprotiv, prema njima treba postupati kao prema razumnim bićima.“ Thomas Bakewell, 19.st
No, postupamo li i danas prema njima tako? Rekla bih da smo napredovali, ne činimo im fizički zlo. Psihički? Nisam baš sigurna. Živimo u svijetu okrutnih riječi, koje mogu napraviti više štete nego udarac. Želimo da ljudi dobiju potrebnu skrb, ali daleko od naših očiju. O svim bolestima pričamo normalno, ali kada je riječ o mentalnim bolestima, spuštamo glas. Ne želimo da to itko čuje. Imati mentalnu bolest još uvijek je neki oblik sramote. „Evo klasičnih stereotipa o ludilu – asocijalnost, otuđenost od stvarnosti i normi konvencionalnog morala, svedenost na razinu životinje, zastrašujuće otpadništvo, nepredvidljivost – a njegova je žrtva u mnogim verzijama priče opsjednuta zloćudnim džinom.“
S namjerom sam se otuđila o knjige, jer volim pričati o problematici psihijatrije. Ova knjiga mi je bila samo paravan. Šalim se. Ludilo u civilizaciji je iznimno pitka i zanimljiva knjiga u kojoj možete kronološki pratiti što se događalo na putu od ludila do psihijatrije kakvu poznajemo danas.
Ne bojte se, ne morate imati diplomu iz područja medicinskih znanosti da bi razumjeli knjigu. Morate samo imati interes. Vjerujte mi, ovo želite pročitati.
Andrew Scull nam piše o tome koliko smo napredovali kao društvo u pogledu ludila. Jesmo li? Presudite sami.
Grickajmo knjige zajedno!
January 25, 2025
Unfortunately, this book wasn’t quite what I expected. It’s really a western-centric look at the history of institutionalisation and medical treatment of people with mental health problems. I was hoping for a more diverse look at cultural perceptions and treatment of people with mental health problems. I also didn’t really love the writing style of this author or the structure of the book. However, there were a few interesting chapters.
March 26, 2020
It’s difficult for me to envision most casual readers getting into ‘Madness in Civilization.’ The topic is interesting but presented in a dry academic fashion. At the beginning of the book, Mr. Scull also goes deeper into the weeds about cultural development than seems necessary. There are groups of pages that describe the past without even a mention of mental illnesses or how different cultures viewed them. Maybe I was being too impatient when I was frequently wishing the author would friggin’ cut more to the chase already. Fortunately, ‘Madness in Civilization’ became more interesting after slogging through about the first one-hundred pages.
The University of California sociology professor has over forty years of experience in the social history of medicine and psychiatry. One aspect of ‘Madness in Civilization’ I found discouraging involved the consistency of the human condition when it comes to relying on superstition. We’re a stubborn lot when it comes to not casting aside unfounded beliefs. It points out that despite our advances in knowledge of various sciences over the last few thousand years there are still sizable segments of the population that believe in possessions by demons; exorcisms; shrines, artifacts, and religious tombs that will heal the afflicted; religious faith healers; or that madness is a consequence of sin. Mr. Scull explains how these silly falsehoods first came about because of ignorance and fear, even before the development of the Bible, then spread and evolved to fit various cultural mindsets. The author also explains how cultural cross-pollination from such major influencers as Greece, China, and the Arab regions expanded our perspectives about the mentally ill. However, most of the focus is on developments in Western Europe and the United States. ‘Madness in Civilization’ addresses such topics as a wide variety of ineffective and many inhumane cures; the creation and evolution of public and for-profit asylums; how madness influenced the arts; bourgeoisie mental maladies; mesmerism; phrenology; degeneration; the creation of psychoanalysis and psychotherapy; the mental trauma of veterans during World War I and II; the germ theory of disease; shock therapy; lobotomies; and better living through chemistry i.e. drugs, baby, drugs. Mr. Scull also addresses our current situations including warehousing our mentally ill in jails; the homeless; the shift towards community treatment; and the development of the controversy surrounding The Diagnostic and Statistical Manual of Mental Disorders handbook. ‘Madness in Civilization’ includes black-and-white photos and illustrations scattered throughout the work and 32 pages of glossy color examples, mostly art representations.
Understandably Mr. Scull’s work has some disturbing material, especially in our recent past and the conditions in present day. The book was published in 2015. There is still much heated professional debate over the ways in which to help those who are mentally ill. Much of what is used, especially medications, are palliatives and not cures. There are even debates about what should be viewed as a mental illness. Despite our scientific advances in the field, there is much that is still unknown about how the brain functions, let alone ways to ameliorate the suffering. ‘Madness in Civilization’ explains how mental illness has been viewed through recorded time and will give the reader a better understanding and, hopefully, more empathy at the challenges confronting such a persistent condition. The book will probably be to your liking if you have a passion for a broader understanding on how we’ve treated and treat the mentally ill.
The University of California sociology professor has over forty years of experience in the social history of medicine and psychiatry. One aspect of ‘Madness in Civilization’ I found discouraging involved the consistency of the human condition when it comes to relying on superstition. We’re a stubborn lot when it comes to not casting aside unfounded beliefs. It points out that despite our advances in knowledge of various sciences over the last few thousand years there are still sizable segments of the population that believe in possessions by demons; exorcisms; shrines, artifacts, and religious tombs that will heal the afflicted; religious faith healers; or that madness is a consequence of sin. Mr. Scull explains how these silly falsehoods first came about because of ignorance and fear, even before the development of the Bible, then spread and evolved to fit various cultural mindsets. The author also explains how cultural cross-pollination from such major influencers as Greece, China, and the Arab regions expanded our perspectives about the mentally ill. However, most of the focus is on developments in Western Europe and the United States. ‘Madness in Civilization’ addresses such topics as a wide variety of ineffective and many inhumane cures; the creation and evolution of public and for-profit asylums; how madness influenced the arts; bourgeoisie mental maladies; mesmerism; phrenology; degeneration; the creation of psychoanalysis and psychotherapy; the mental trauma of veterans during World War I and II; the germ theory of disease; shock therapy; lobotomies; and better living through chemistry i.e. drugs, baby, drugs. Mr. Scull also addresses our current situations including warehousing our mentally ill in jails; the homeless; the shift towards community treatment; and the development of the controversy surrounding The Diagnostic and Statistical Manual of Mental Disorders handbook. ‘Madness in Civilization’ includes black-and-white photos and illustrations scattered throughout the work and 32 pages of glossy color examples, mostly art representations.
Understandably Mr. Scull’s work has some disturbing material, especially in our recent past and the conditions in present day. The book was published in 2015. There is still much heated professional debate over the ways in which to help those who are mentally ill. Much of what is used, especially medications, are palliatives and not cures. There are even debates about what should be viewed as a mental illness. Despite our scientific advances in the field, there is much that is still unknown about how the brain functions, let alone ways to ameliorate the suffering. ‘Madness in Civilization’ explains how mental illness has been viewed through recorded time and will give the reader a better understanding and, hopefully, more empathy at the challenges confronting such a persistent condition. The book will probably be to your liking if you have a passion for a broader understanding on how we’ve treated and treat the mentally ill.
August 14, 2021
The book’s focus (insomuch as the book is focused) is on how societies historically understood, explained, and processed the changing concepts and theories—as well as the realities—of insanity. Often this showed up in a culture’s art, which the book highlights and has many examples of. The scope is too vast for one book, or one approach, to give definitive justice so I should judge this book accordingly. Ok, we have a fascinating concept which the author does a pretty good job keeping interesting.
What I wasn’t expecting was the casual, idiosyncratic, and often flippant tone throughout. It’s like a professor entertaining an upper-level class full of students who knowingly nod at the in-jokes. The book is full of asides and out-of-the-blue jabs without context. I’ve never read Foucault, I can’t recall what exactly Scientologists feel about psychiatry, and I have no real clear idea what the psychological canonizers think of Freud. So before giving the sucker punches, a little context would have been helpful.
The author also doesn’t seem to be especially sympathetic to either the afflicted or the people trying to help them. Hemingway committed suicide by “shooting himself with a shotgun and blowing his head off.” What strange, lurid, unsympathetic phrasing. And every advance in understanding and helping sufferers of mental health is presented as a power grab and/or a way to make a better living*. Maybe the world is indeed primarily ruled by avarice. But it’s a pretty cynical take.
I’m giving it a 3 because who cares? Foucault thinks these things are essentially meaningless.
*Well, maybe burning witches is a bit over the top.
What I wasn’t expecting was the casual, idiosyncratic, and often flippant tone throughout. It’s like a professor entertaining an upper-level class full of students who knowingly nod at the in-jokes. The book is full of asides and out-of-the-blue jabs without context. I’ve never read Foucault, I can’t recall what exactly Scientologists feel about psychiatry, and I have no real clear idea what the psychological canonizers think of Freud. So before giving the sucker punches, a little context would have been helpful.
The author also doesn’t seem to be especially sympathetic to either the afflicted or the people trying to help them. Hemingway committed suicide by “shooting himself with a shotgun and blowing his head off.” What strange, lurid, unsympathetic phrasing. And every advance in understanding and helping sufferers of mental health is presented as a power grab and/or a way to make a better living*. Maybe the world is indeed primarily ruled by avarice. But it’s a pretty cynical take.
I’m giving it a 3 because who cares? Foucault thinks these things are essentially meaningless.
*Well, maybe burning witches is a bit over the top.
April 17, 2023
Esta monografía aborda la locura y como las diferentes culturas han lidiado con ella, focalizandose luego en la civilización occidental. Las conclusiones finales me resultaron bastante pesimistas y escalofriantes. El negocio de los psicofármacos, las categorías "inventadas" de los DSM... todo esto resulta muy inquietante y sugiere que la psiquiatría moderna sigue en pañales. Como médico y como paciente lo veo y lo siento también de esa manera. Será este siglo o esta década el periodo en el que veremos un real progreso en el entendimiento de la locura?
February 18, 2017
The author is an academic who is specialises as a social researcher into the nature of 'madness' or mental illness as we commonly define it. There is plenty of context across cultures and the ages. But it is the final chapter that inspires. Entitled A Psychiatric Revolution? The author contends that the brain is the final frontier and we are still decades away from any real understanding of 'madness'. The brain has billions and billions of connections making the cause mental illness very hard to find. 'Human development may not always proceed smoothly and without flaws, and somewhere in that murky mix of biology and the social lie the roots of madness.' The puzzle of 'unreason'.
There is also the painful reality that many of the treatments over time have caused more harm than good.
The final chapter on the biology/body vs social/mind approach that clinicians wrestle with (see DSM 1 - 5) could easily provide fodder for an entire book - which hopefully is in the works.
There is also the painful reality that many of the treatments over time have caused more harm than good.
The final chapter on the biology/body vs social/mind approach that clinicians wrestle with (see DSM 1 - 5) could easily provide fodder for an entire book - which hopefully is in the works.
August 4, 2017
A jarring account of madness, as biased as it is artistic. This treatise is more of a cry for social change than a dry academic manuscript. A cynical, jabbing exposé of humanity's struggles with the unknown, which ultimately and irrevocably continued to worsen the original problem, rather than making it better - often in the interests of money, power and status, as is often the case. A wonderful read for those contemplating the human rights of the mentally ill, a dramatic and incredibly empowering offer for the mentally ill themselves. For all the shortcomings of the writing - often ranting and at times confusing prose, this deserves the 5 stars I gave it. A riveting experience.
December 8, 2017
Considering the respectable thickness of this book, the fact that I was continuously engaged (maybe not enthralled, but definitely engaged) makes the writing praiseworthy. It was accessible yet comprehensive, and not a dry read like many other historical accounts. The pictures strewn throughout probably helped. In summary; our understanding and treatment of madness has changed drastically throughout the ages, but the fundamental explanation behind its causes remains elusive, "inescapably part and parcel of civilisation itself".
July 27, 2017
Scull's history of mental illness 'from the Bible to Freud' is as fascinating as it is disturbing. It is not merely a book about psychiatry or medicine, it goes beyond clinical and scientific ideas exploring cultural expressions and notions of madness through art, literature and philosophy. Scull writes both engagingly and accessibly by mixing academic terms with wry humour. An absolutely brilliant read.
January 6, 2016
Compendious, erudite, and fascinating.
November 6, 2019
Makes a fascinating subject dry and headache-inducing. DNF
January 10, 2020
Madness has always presented a difficult challenge to civilization and it has drawn out the assumptions that exist behind a society in how it views those who are unable to keep up its demands. What forces or problems do we blame such mental problems for? How do we attempt to ameliorate the conditions of those who suffer? Who pays for their treatment? How do we learn about the etiology of these problems and how they may be fixed if it is at all possible? None of these are simple questions and there are clear patterns that exist within societies and pendulum swings where given treatments are viewed as being immensely useful cures and then turned on within only a few years and viewed as cruel and inhumane even as the same problems exist or even get worse. Our society at present does not do well with mental problems but it is not as if there are very many good options when society as a whole is unwilling to spend a great deal of money to take care of those who cannot take care of themselves very well. We drug them or jail them in some fashion or let them eke out a miserable life as homeless people, treatment no more kind than that of ancient times when dealing with Legion and his ilk.
This book is about 400 pages long or so and is divided into twelve chapters. The author begins with acknowledgements and then a look at the way society has always confronted madness (1). After that there is a look at madness in the ancient world (2) and how it was confronted at the dawn of modernity (3) thanks to the insights of medieval Muslim practitioners. After that the author discusses the relationship between melancholy and madness and how it was viewed by the early moderns (4) and how society quickly sought madhouses to deal with the mass of insane people with half-mad mad doctors to tend to them (5) generally ineffectually. This leads to a discussion of the change of terminology to deal with nerves (6) with no greater success in treatment as well as the great confinement in asylums that spread across the civilized world in the late 19th and early 20th centuries (7). After that the author discusses the problems of degeneration and despair that were focused on in the mid 20th century (8) as well as the hopes of the talking cure (9) and the desperate measures that included lobotomies and shock therapy (10). The book then ends with a discussion of the search for alternative solutions and the trend towards deinstitutionalizing people (11) and the current focus on drugs (12) as the cure for mental illness, after which the book ends with notes, a bibliography, sources of illustration, and an index.
In reading this book it is readily apparent that the author is not really looking to promote any particular solutions to the problem of the mentally ill. There is certainly an agenda here, and that agenda is to critique current trends in mental health and to delegitimize the professions related to psychiatry by pointing out their origins as well as the lack of effectiveness of their techniques. The author looks somewhat more kindly on the traditional methods of the ancient world, whether one looked at the exorcism of the Bible or the practical care that was provided by many traditional techniques, although the author shows a general tendency to critique those who thought that they possessed sound and scientific knowledge about the workings of the mind from the ancient world to today. As the author notes, no age of science has ever managed to explain and to treat the mental problems that its society has wrestled with, including our own, and the author is not optimistic that this trend will quickly be reversed.
This book is about 400 pages long or so and is divided into twelve chapters. The author begins with acknowledgements and then a look at the way society has always confronted madness (1). After that there is a look at madness in the ancient world (2) and how it was confronted at the dawn of modernity (3) thanks to the insights of medieval Muslim practitioners. After that the author discusses the relationship between melancholy and madness and how it was viewed by the early moderns (4) and how society quickly sought madhouses to deal with the mass of insane people with half-mad mad doctors to tend to them (5) generally ineffectually. This leads to a discussion of the change of terminology to deal with nerves (6) with no greater success in treatment as well as the great confinement in asylums that spread across the civilized world in the late 19th and early 20th centuries (7). After that the author discusses the problems of degeneration and despair that were focused on in the mid 20th century (8) as well as the hopes of the talking cure (9) and the desperate measures that included lobotomies and shock therapy (10). The book then ends with a discussion of the search for alternative solutions and the trend towards deinstitutionalizing people (11) and the current focus on drugs (12) as the cure for mental illness, after which the book ends with notes, a bibliography, sources of illustration, and an index.
In reading this book it is readily apparent that the author is not really looking to promote any particular solutions to the problem of the mentally ill. There is certainly an agenda here, and that agenda is to critique current trends in mental health and to delegitimize the professions related to psychiatry by pointing out their origins as well as the lack of effectiveness of their techniques. The author looks somewhat more kindly on the traditional methods of the ancient world, whether one looked at the exorcism of the Bible or the practical care that was provided by many traditional techniques, although the author shows a general tendency to critique those who thought that they possessed sound and scientific knowledge about the workings of the mind from the ancient world to today. As the author notes, no age of science has ever managed to explain and to treat the mental problems that its society has wrestled with, including our own, and the author is not optimistic that this trend will quickly be reversed.
June 12, 2025
A masterful, readable cultural history that stops short of its most radical implications
Andrew Scull’s Madness in Civilization is a richly woven narrative tracing how Western societies have historically defined, depicted, and treated “madness.” It’s billed as a cultural history, but it’s more than that—it’s a meditation on how language, belief, art, and power have shaped our understanding of minds that don’t conform.
Despite some Goodreads claims to the contrary, I found this book incredibly readable. I finished it in about an hour. Scull’s use of visual art and literature is not just decorative—it’s structural. His references to Bosch, Goya, and others don’t merely illustrate madness; they embody the cultural lens through which madness was filtered and reframed across time. That rhetorical technique—tying epistemology to aesthetics—deserves more credit than most reviewers give it.
Scull begins with ancient religious conceptions of madness—not just as affliction, but as divine gift, especially in pre-modern and pre-Arabic contexts. From there, he tracks the humoral theory, the moral panic of the Middle Ages, the rise of the asylum system during the Enlightenment (which he rightly critiques as reductionist), and the eventual turn toward Freudian, pharmaceutical, and modern psychiatric models.
But here’s my biggest critique: he doesn’t go far enough. The groundwork is clearly there to explore how “madness” historically swallowed up what we now classify as cognitive disabilities—intellectual disabilities, Down syndrome, cerebral palsy, bipolar disorder, etc. All of these were once indistinguishably lumped under the umbrella of insanity, defect, or moral failing. And yet Scull stops short of unpacking how this collapsing of categories impacted disabled people directly. That’s a major omission in a book that otherwise insists on showing how medical and cultural paradigms inflict real human consequences.
If you’re interested in that broader discussion—of how “normalcy” itself functions as a coercive ideal—I’d recommend pairing this with Jonathan Mooney’s Normal Sucks. It’s far more polemic (in the actual sense of the word), but it speaks to exactly the silence Scull leaves behind.
Overall, I think this is an excellent book. It’s not perfect, but it’s intellectually rich, culturally grounded, and surprisingly readable. I just wish it had pushed harder into the territory it flirts with—because the legacy of “madness” doesn’t end with the asylum. It lives on in the way we pathologize, exclude, and medicalize all kinds of non-normative minds.
Andrew Scull’s Madness in Civilization is a richly woven narrative tracing how Western societies have historically defined, depicted, and treated “madness.” It’s billed as a cultural history, but it’s more than that—it’s a meditation on how language, belief, art, and power have shaped our understanding of minds that don’t conform.
Despite some Goodreads claims to the contrary, I found this book incredibly readable. I finished it in about an hour. Scull’s use of visual art and literature is not just decorative—it’s structural. His references to Bosch, Goya, and others don’t merely illustrate madness; they embody the cultural lens through which madness was filtered and reframed across time. That rhetorical technique—tying epistemology to aesthetics—deserves more credit than most reviewers give it.
Scull begins with ancient religious conceptions of madness—not just as affliction, but as divine gift, especially in pre-modern and pre-Arabic contexts. From there, he tracks the humoral theory, the moral panic of the Middle Ages, the rise of the asylum system during the Enlightenment (which he rightly critiques as reductionist), and the eventual turn toward Freudian, pharmaceutical, and modern psychiatric models.
But here’s my biggest critique: he doesn’t go far enough. The groundwork is clearly there to explore how “madness” historically swallowed up what we now classify as cognitive disabilities—intellectual disabilities, Down syndrome, cerebral palsy, bipolar disorder, etc. All of these were once indistinguishably lumped under the umbrella of insanity, defect, or moral failing. And yet Scull stops short of unpacking how this collapsing of categories impacted disabled people directly. That’s a major omission in a book that otherwise insists on showing how medical and cultural paradigms inflict real human consequences.
If you’re interested in that broader discussion—of how “normalcy” itself functions as a coercive ideal—I’d recommend pairing this with Jonathan Mooney’s Normal Sucks. It’s far more polemic (in the actual sense of the word), but it speaks to exactly the silence Scull leaves behind.
Overall, I think this is an excellent book. It’s not perfect, but it’s intellectually rich, culturally grounded, and surprisingly readable. I just wish it had pushed harder into the territory it flirts with—because the legacy of “madness” doesn’t end with the asylum. It lives on in the way we pathologize, exclude, and medicalize all kinds of non-normative minds.
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November 13, 2020"It makes no sense to regard the brain (as biological reductionists do) as an asocial or a pre-social organ, because in important respects its very structure and functioning are a product of the social environment. For the most remarkable feature of the human brain is how deeply and profoundly sensitive it is to psychosocial and sensory inputs. What this means, as the neuroscientist Bruce Wexler (b. 1947) puts it, is that ‘our biology is social in such a fundamental and thorough manner that to speak of a relation between the two suggests an unwarranted distinction’ . . .
It is hard to imagine, at least for the most severe forms of mental aberration, that biology will not prove to play an important role in their genesis. But will madness, that most solitary of afflictions and most social of maladies, be reducible at last to biology and nothing but biology? There one must have serious doubts. The social and the cultural dimensions of mental disorders, so indispensable a part of the story of madness in civilization over the centuries, are unlikely to melt away, or prove to be nothing more than epiphenomenal features of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been. It remains a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilization itself."
It is hard to imagine, at least for the most severe forms of mental aberration, that biology will not prove to play an important role in their genesis. But will madness, that most solitary of afflictions and most social of maladies, be reducible at last to biology and nothing but biology? There one must have serious doubts. The social and the cultural dimensions of mental disorders, so indispensable a part of the story of madness in civilization over the centuries, are unlikely to melt away, or prove to be nothing more than epiphenomenal features of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been. It remains a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilization itself."
September 21, 2025
A riveting exploration of madness through the lens of its evolution within civilisation.
I can only quote the last sentences of Andrew Scull:
“But will madness, that most solitary of afflictions and most social of maladies, be reductible at last to biology and nothing but biology? There one must have serious doubts.
The social and the cultural dimensions of mental disorders, so indispensable a part of the story of madness in civilisation over the centuries, are unlikely to melt away, or prove to be nothing more than epiphenomenal features of so universal a feature of human existence.
Madness indeed has its meanings, elusive and evanescent as our attemps to capture them have been. It remains a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilisation itself.”
I can only quote the last sentences of Andrew Scull:
“But will madness, that most solitary of afflictions and most social of maladies, be reductible at last to biology and nothing but biology? There one must have serious doubts.
The social and the cultural dimensions of mental disorders, so indispensable a part of the story of madness in civilisation over the centuries, are unlikely to melt away, or prove to be nothing more than epiphenomenal features of so universal a feature of human existence.
Madness indeed has its meanings, elusive and evanescent as our attemps to capture them have been. It remains a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilisation itself.”
January 23, 2025
With the caveat that this book is almost exclusively a "western" cultural history of mental illness, it is none the less a fascinating read. Paints a picture of an ongoing battle between biological, social and psychological explanations for mental illness and leaves us in the current landscape in which the biological has won out in the medical field but is far from a comprehensive or convincing explanation. The references to art, poetry and literature throughout the book really bring it alive. The sections on psychiatry in WWI were particularly devastating and horrifying. Would highly recommend to anyone seeking to learn more about the history of the treatment of mental illness in the western world.
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