Overall Take
Quick read. The pre-1920s content was more thorough and engaging to me. I especially liked the sections on the interplay between religion and mental illness (e.g., how religious themes gave people a framework to understand their atypical mental experiences) as well as the history of asylums (e.g., I found it interesting that documentation for the use of restraints in England has been legally required since the 1830s).
The organization was sometimes confusing: it often linked topics by theme rather than timeline, so different chapters ended up covering the same people/content in oddly overlapping ways. Also there were often topics added to chapters because "isn't this interesting" even though they didn't fit the timeline. I think partly this is because Porter recycled material for this book from some of his other books, such as his "A Medical History of Humanity."
I think there could have been more material on first-person accounts of the experience of mental illness throughout history and how it has changed. There were a few of these and they were among the most interesting sections of the book for me.
There was, I think, a little bit too much content on the relationship between the production of art and mental illness. This was maybe 10% of the book. Especially since the takes were generally very surface-level.
Finally, it probably should be retitled "Madness in the West: A Brief History" because it had almost nothing on cultures outside of Europe and the US. And this is not for a lack of material; for example, a lot of the earliest history of psychiatry can be found in the Islamic Golden Age and this only received passing mention.
Quotes
"Homeric man was not the introspective self-conscious being who populates Socrates’ dialogues a few hundred years later—indeed, The Iliad has no word for ‘person’ or ‘oneself"
"In his Anatomy of Melancholy (1621), the Oxford don Robert Burton thus identified the Tempter as the true author of despair and suicide, if often working through such victims as the sick whose weaknesses made them particularly susceptible. His contemporary, the Anglican clergyman Richard Napier, who doubled as a doctor and specialized in healing those ‘unquiet of mind’, found that many who consulted him were suffering from religious despair, the dread of damnation aroused by Calvinist Puritanism, the seductions of Satan, or fear of bewitchment."
"The witch craze which gathered momentum across Europe from the late fifteenth century, peaking around 1650, likewise viewed uncontrolled speech and behaviour as symptoms of satanic maleficium (malice) directed by witches who had compacted with the Devil. In the conflagration of heresy-accusations and burnings stoked by the Reformation and Counter-Reformation, false doctrine and delusion formed two sides of the same coin: the mad were judged to be possessed, and religious adversaries were deemed out of their mind."
"The bloody excesses of witch– and heresy-hunting—over 200,000 people, mainly women, were executed during the witch craze—eventually bred official and public scepticism about demoniacal possession."
"In later centuries, ‘hysterical’ women were stigmatized much as ‘witches’ had been, though they escaped legal penalties: misogyny remained, only the diagnosis changed. In a revealing letter to his friend Wilhelm Fliess, Freud noted how he could understand the witch-hunters of bygone times."
"The Thirty Years War (1618–48) on the Continent and the Civil Wars in Britain (1642–51) stirred strong reactions against religio-political extremism, condemned as ruinous to public order and personal safety alike."
"[To] Aretaeus, depression was a grave condition, its delusions, obsessions, and idées fixes highly destructive. ‘The melancholic isolates himself, he is afraid of being persecuted and imprisoned, he torments himself with superstitious ideas, he hates life … he is terror-stricken, he mistakes his fantasies for the truth … he complains of imaginary diseases, he curses life and wishes for death.’"
"All societies judge some people mad: any strict clinical justification aside, it is part of the business of marking out the different, deviant, and perhaps dangerous. Such ‘stigma’, according to the American sociologist Erving Goffman, is ‘the situation of the individual who is disqualified from full social acceptance’. ... This demonizing process may be regarded as psychologically and anthropologically driven, arising out of deep-seated and perhaps unconscious needs to order the world by demarcating self from other."
"Regarding his committal to Bethlem, the Restoration playwright Nathaniel Lee reputedly declared: ‘They called me mad, and I called them mad, and damn them, they outvoted me.’"
"Greek and Roman law sought to prevent [people with a serious mental illness] from destroying life, limb, and property, and made guardians responsible for them. ‘If a man is mad’, wrote Plato in the Laws, ‘he shall not be at large in the city, but his family shall keep him in any way they can.’"
"The medical ‘dynasty’ of the Monros at Bethlem—Dr James Monro was succeeded by his son John, who was succeeded by his son Thomas, who was then succeeded by his son Edward, mirroring the four Georges who ran the nation—did not prevent that institution from becoming hidebound and corrupt: quite the opposite in fact."
"Physician to London’s new St Luke’s Asylum and owner of a private asylum, Battie conceded in the 1750s that a fraction of the insane did indeed suffer from ‘original insanity’, which, like original sin, was incurable. Yet far more common was ‘consequential insanity’—i.e. insanity resulting from events—for which the prognosis was favourable. To maximize cures, argued Battie and his many followers, what was required was early diagnosis and confinement (before the condition grew confirmed), and then a regime tailored to the individual case." - Personalized psychiatry in the 1750s
"During the Reign of Terror, a Parisian tailor challenged the execution of Louis XVI. Misconstruing a conversation he overheard, he then became convinced he was himself about to be guillotined. This delusion grew into a fixation necessitating his confinement. By way of psychotherapy, Pinel staged a complicated demonstration: three doctors, dressed up as magistrates, appeared before the tailor. Pretending to represent the revolutionary legislature, the panel pronounced his patriotism to be beyond reproach, ‘acquitting’ him of any misdeeds. The mock trial, Pinel noted, caused the man’s symptoms to disappear at once. "
"Radical undercurrents within the medical profession itself moreover insisted that, with the best will in the world, asylums must prove counter-productive ‘manufactories of madness’: herded together, lunatics would be reduced to the lowest common denominator." - 20th century critiques of asylums