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The Most Solitary of AfflictionsReview - The Most Solitary of Afflictions
Madness and Society in Britain, 1700-1900
by Andrew Scull
Yale University Press, 1993
Review by Mark Welch, Ph.D.
Mar 21st 2006 (Volume 10, Issue 12)

Every once in a while you reread a book that profoundly interested you at the time, and you wonder if it will have quite the same impact. Will it still seem as important or as revelatory, or even as engaging a read? Such is the case with Andrew Scull's seminal work on the history of psychiatry and the asylum in England and Wales from the beginning of the eighteenth up to the end of the nineteenth century. Although it has not reappeared in a new edition, or been updated, it still reveals a depth and rigor of scholarship that not only marks it out to be an outstanding work of its period, but one that has stood the test of time.

Reading Scull's elegant and rhythmic prose is a pleasure. He marshals an impressive knowledge of the literature and weaves the together social, cultural, political and scientific factors that shaped the development of psychiatry as we know it. He uses original material to illustrate the sincere concerns and laudable intentions of many of the early practitioners, but a contemporary eye to show the often disastrous consequences. He attempts to describe and explain how and why madness became the province of the medical profession, and how the psychiatric institution emerged.

From the first line, the title indeed is taken from a line in Michael MacDonald's wonderful book, Mystical Bedlam, Scull infuses his work with a profound humanistic concern. He makes the reader aware that this is not just abstract social history, but the lives of men and women who in turn suffered abuse, stigma, mistreatment, misunderstanding and all manner of terror in addition to the unchecked symptoms of their illness.

Although there have been developments in scholarship in this area in the last dozen years (not least his own) Scull's exposition of the tragic fate of the mentally ill, his deep concern for the personal experience and his sympathy for the human condition keep this text at the forefront. He is clear that there are points at which he would take issue with other critiques of psychiatry. He rejects the arguments of Szasz and what he terms little more than a conspiracy theory of anti-psychiatry. It is for him a gross oversimplification, an almost adolescent romanticism that understands little of the suffering involved. But he does not subscribe to the Whiggish or revisionist accounts either, because they tend to be too one sided and unbalanced. It seems important to remember that so much of the history of the development of the asylum was well-intentioned, even if the results were sometimes worse than ever. This has the makings of a Greek tragedy, for the good intentions are at once both the greatest strength and the greatest weakness of the psychiatric reformers.

The final chapter finds Scull in a more reflective mood. He considers with some sadness the consequences of deinstitutionalization. It would be interesting to read his present consideration of what he wrote then: have we continued with a blind allegiance to the illusion of community care without the necessary supports and infrastructure, heedless that the freedom it gives to some is the freedom to be homeless, to be unemployed, to be exploited, to live in substandard housing, to be easy prey to the criminal and unscrupulous, to be untreated, uncared for and not to belong?

Nevertheless, there remain some surprising omissions. He does not, for example, consider the issue of the criminally insane or their incarceration to any extent. This may be a puzzle in view of the seminal effect of the M'Naughten case in the recognition of mental illness being distinct from criminality. He does not interrogate to the degree that might be expected, the various Lunacy Acts, although the activities of the Lunacy Commissioners is an important aspect of the book.

But it is really caviling to complain in this way. The Most Solitary of Afflictions remains a vital and foundational text for anyone interested in the history of psychiatry. It is rich in scholarship and detail, and provoking in its argument. Its tone is warm and pragmatic, devoid of cant and clear and precise. It should be treasured and we are lucky that there are still people like Andrew Scull who can write as effectively and as movingly on the history of some of our most dispossessed citizens. It was a fine read in 1993 and it remains so today.

 

2006 Mark Welch

 

Mark Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre for Nursing & Mental Health.


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