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From Madness to Mental HealthReview - From Madness to Mental Health
Psychiatric Disorder and Its Treatment in Western Civilization
by Greg Eghigian (Editor)
Rutgers University Press, 2009
Review by Mark Welch, Ph.D.
Nov 2nd 2010 (Volume 14, Issue 44)

There is no real shortage of histories of psychiatry, but there is nothing comparable to Eghigian’s compilation of key historical source texts that illuminate the changing concepts of constructs of mental disorders over time in From Madness to Mental Health.

This anthology of readings begins with the Book of Samuel (which is dated at about 960 BCE) and moves chronologically through other ancient texts such as The Bacchae and Hippocrates through medieval and pre-modern works like Julian of Norwich’s Revelations of Divine Love, written in the 1390s and Ibn Sena (Avicenna) to the beginning of the Enlightenment in Pinel and on to modern authors such as Freeman, Dix; Beck; and Rogers. It draws from religious texts, clinical case studies, memoirs, academic lectures, hospital and government records, legal and medical treatises, and art collections and significantly includes a well-researched compendium of first-person narratives on mental illness which is credited to Gail A. Hornstein.

The choice of which texts to include, and of course those to exclude, is one of the most interesting aspects of the book. It is probably uncontroversial to include Biblical references. After all the stories of Saul and Nebuchanezzar are well known and widely acknowledged. Similarly with the Greeks. Playwrights poets and historians all had their stories to tell. The medieval selection begins to reveal some of Eghigian’s thesis. There is an extract from Burton on the subject of melancholia, as well as the more rarely seen commentary on “The Law Relating to Natural Fools, Mad-Folks and Lunatick Persons” by John Brydall written sometime around 1700. The inclusion of Ibn Sena, Sarabiyun Ibn Ibrahim and Rufus of Ephesus clearly shows the concern with the impact of the discourse outside Western Europe and the rich heritage that can be found there, even though the subtitle of the book refers to Western civilization.. However, it is clear that Eghigian wants us to see the emerging concepts in psychiatry as deeply layered and reflexive, and most of all historical.

The section that deals with the early modern period, what he calls The Age of Optimism, also has some interesting choices. It is instructive, for example, to read the text of the judgment of the M’Naughten Rules, something that in one very recognizable form or another still lives with us in almost every piece of mental health legislation in the Western world. In a similar way the government reports and commissions he cites show the development of a social response and the beginnings of social policy with regard to mental illness and the mentally ill. The end of the nineteenth century is represented by the familiar names of Freud, Charcot, Krafft-Ebing and Kraepelin and then the book moves into its third section, The Militant Age.

In this section, which roughly covers the period from World War 1 to sometime in the mid-1960s, give or take, there is probably more controversy and contention than in any other. However, whatever the argument is that is put forward, it is advanced with a rather chilling certainty. There are humane and agonized reflections from WHR Rivers, possibly best known for his role in memoirs of Siegfried Sassoon and Robert Graves, and also very interesting texts from the eugenic movements in Europe and the United States, not a widely discussed era. There is the verdict in the case of Buck versus Bell from 1927 concerning forced sterilization and a very rarely published, and very important selection of documents from Nazi Germany including the T-4 and 14f13 programs and the Hadamar experiments. It is salient to note at this point that  Martin Niemoller got it slightly wrong when he said that, “First, they came for the socialists”. First, they actually came for the mentally ill and the handicapped. The inclusion of this alone may signify an important shift in psychiatric histories and a consideration of the political and social role of psychiatry and its definitions and scope that sits outside the libertarian viewpoint. The Militant Age concludes with the classic anti-psychiatry texts of Szasz, the critique of Fanon, the Trieste experiment of Basglia and the Declaration of Hawaii by the World Psychiatric Association in which the promotion of mental health is given as much emphasis as the treatment of mental illness.

The final section, The Psychoboom, deals mainly with counseling psychiatry and the developments of models of treatment such as CBT and so on. It considers the impact of feminist theory and the profound changes in mood brought about by DSM-III, but does not review DSM-IV. It does not, somewhat surprisingly, consider many of the advances in psychopharmacy or neurobiology which seem to be so important for current practice. However, by the inclusion of the extensive bibliography of first person narratives, it does draw attention to the continuing importance of the phenomenological and the subjective experience, the move from patients to clients to consumers and the acknowledgement of the experience and recovery from mental disorders. Perhaps this confronting one of the last taboos.

It would be impossible for any anthology like this to be so comprehensive as to please everybody, and there could be lists of vital texts five times as long as this. As is explained some choices were made because of wide familiarity (as in Shakespeare) and some because of excessive copyright demands (and Cerletti is mentioned by name), but Eghigian has brought together a cohesive narrative that shows the good, the bad and the ugly natures of psychiatric practice. He mainly considers the written word, and although there are a number of illustrations scattered through the book none date from any later than the late nineteenth century. These are very welcome, but they do not add significantly to the thesis as they generally lie outside the commentary. All in all, the book is a very important addition to the literature, and will appeal to serious scholars and interested general readers. It is a great resource, well-referenced and thoughtfully constructed. It should be on the reading list of every clinician training course, no matter what the discipline. A very impressive achievement indeed.

 

© 2010 Mark Welch

 

Mark Welch, Ph.D., British Columbia


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