Social Order/Mental Disorder

Anglo-American Psychiatry in Historical Perspective

Andrew Scull

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138315891
• eBook ISBN: 9780429850363
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Social Order/Mental Disorder represents a provocative and exciting exploration of social response to madness in England and the United States from the eighteenth through the twentieth centuries. Scull, who is well-known for his previous work in this area, examines a range of issues, including the changing social meanings of madness, the emergence and consolidation of the psychiatric profession, the often troubled relationship between psychiatry and the law, the linkages between sex and madness, and the constitution, character, and collapse of the asylum as our standard response to the problems posed by mental disorder.

This book is emphatically not part of the venerable tradition of hagiography that has celebrated psychiatric history as a long struggle in which the steady application of rational-scientific principles has produced irregular but unmistakable evidence of progress toward humane treatments for the mentally ill. In fact, Scull contends that traditional mental hospitals, for much of their existence, resembled cemeteries for the still breathing, medical hubris having at times served to license dangerous, mutilating, even life-threatening experiments on the dead souls confined therein. He argues that only the sociologically blind would deny that psychiatrists are deeply involved in the definition and identification of what constitutes madness in our world – hence, claims that mental illness is a purely naturalistic category, somehow devoid of contamination by the social, are taken to be patently absurd. Scull points out, however, that the commitment to examine psychiatry and its ministrations with a critical eye by no means entails the romantic idea that the problems it deals with are purely the invention of the professional mind, or the Manichean notion that all psychiatric interventions are malevolent and ill-conceived. It is the task of unromantic criticism that is attempted in this book.

CHAPTER ONE

Reflections on the Historical Sociology of Psychiatry

The history of the victors, for the victors, and by the victors is not only indecent, but also bad history and bad sociology, for it makes us understand less the ways in which human societies operate and change.

—TEODOR SHANIN,

Foreword to The Agrarian Question and the Peasant Movement in Colombia
by Leon Zamosc

Madness constitutes a right, as it were, to treat people as vermin.

— LORD SHAFTESBURY,

Diaries, 5 September 1851

“Well, in our country,” said Alice, still panting a little, “you’d generally get somewhere ele—if you ran very fast for a long time, as we’ve been doing.”

“A slow sort of country!” said the Queen. “Now, here, you see, it takes all the running you can do to keep in the same place.”

— LEWIS CARROLL,

Through the Looking Glass

For more than a decade and a half now, I have been preoccupied with understanding social responses to madness in Britain and the United States. Some of my work, dealing with the analysis of the origins and implementation of contemporary mental health policies, seems to fall within the conventional boundaries of sociology as the mainstream of the American profession defines them (though this is largely the result of intellectual accident rather than design). For the most part, however, as the contents of this volume reveal, my interests have been heavily historical, a choice that has quite consciously reflected both my intellectual conviction that an adequate sociological understanding is necessarily a historically grounded understanding and, to be candid, the great pleasure I find in rummaging about in the past.

Intellectual choices, of course, are not made in a vacuum, flowing in substantial measure from a complex interaction between biography and circumstance of which we are seldom fully aware. In largely unintended ways, I suspect that my formal education at Balliol and Princeton contributed to my initial interest in psychiatric history. (One’s acquisition of a certain intellectual capital and the natural tendency to work over the years on a set of interrelated problems makes one’s early decisions of more moment than is generally realized at the time, so that in retrospect I can hardly be surprised at my continuing fascination with this subject matter.)

Undergraduates at Oxford are not allowed to take a degree in sociology, a peculiar prejudice that has doubtless been reinforced in the present reactionary political climate, given the (not wholly mistaken) notion that there is something inherently subversive about the sustained intellectual analysis of social institutions. The immediate consequence of this policy in my case was that I acquired a rather broad education in philosophy and in a range of social sciences, rather than the narrow indoctrination into a particular academic discipline more characteristic of English university instruction. Because I have always relished the freedom to trespass across established disciplinary boundaries, I think that among sociology’s prime attractions for me was my sense of the capaciousness of the intellectual territory it sought to embrace.

This sense of the scope and ambition of the subject reflected the fact that the relatively small dose of sociology I had received at Oxford concentrated heavily on the work of Marx, Durkheim, and Weber, together with such atypical mid-twentieth-century sociologists as Barrington Moore and C. Wright Mills. Mainstream American sociology of the late 1960s, with its narrow, presentist bias, its crude scientism, and its preoccupation with method at the expense of substance, was infinitely less appealing. One might reasonably expect, therefore, that my passage into graduate school in the United States would have produced severe disillusionment. I was fortunate enough, however, to have chosen Princeton for my graduate training: fortunate in that, having cleared certain methodological and statistical hurdles, I (like the rest of my cohort there) was left almost entirely to my own devices, free to pursue my own intellectual whims and fancies.

While not without its hazards—virtually all my fellow students have disappeared without professional trace—this situation did have certain distinct advantages. In particular, when my reading of Foucault and Rothman had led me to an interest in matters psychiatric, no one was disposed to dissuade me from studying lunacy in the nineteenth century simply because the sociological audience for such work might prove vanishingly small. Soon I found myself fascinated by a whole set of interrelated questions about changing social responses to mental disturbance and the mentally disturbed and equally hooked on the pleasures of playing historical detective-—a double addiction from which I have neither sought nor wished to escape.

There can be little question that, for many American sociologists, it must seem eccentric for one of their number to exhibit a persistent concern with such topics as eighteenth-century beliefs about madness, a lawsuit launched by an obscure and otherwise unmemorable middle-aged spinster in the late 1840s, the biography of a nineteenth-century alienist, the architecture of Victorian loony bins, and historiographic disputes about the interpretation of nineteenth-century lunacy reform. At the same time, only the most intellectually obtuse could avoid recognizing that a certified member of the sociological community is likely to be greeted with great wariness and suspicion by card-carrying professional historians, even if he somehow escapes being shot at by the border guards who so zealously patrol the artificial boundaries we have erected to distort the study of human society. Yet the intellectual rewards that can flow from resisting entrenched pressures to respect established disciplinary boundaries seem to me amply to justify a refusal to embrace conventional pieties about the territories that belong to the historian or to the sociologist.

One of the most pernicious, albeit widespread, views of the uneasy relationship between these two subspecies of homo academicus, while emphasizing that most historians and sociologists have better sense than to invade each other’s ecological niche, suggests that when they do threaten to occupy the same social space, competition is reduced through a kind of division of intellectual labor. In the sociologist’s version of this fairy tale, historians are portrayed as underlaborers for the queen of social sciences, engaged in the relentless pursuit of the particular without regard for its general theoretical significance, empiricists whose blind archival burrowings produce mounds of “facts,” which then serve as the grist for the grander, explanatory science to ponder and process. As Joseph Gusfield puts it, “Historians tell stories without conclusions. [Historical] sociologists tell stories that are mostly conclusions.”¹

That this patronizing and, in my view, intellectually misguided set of claims has aroused considerable resentment in historical circles is scarcely surprising. Most historians, after all, quite rightly see themselves as engaged in the task of explaining and not simply reproducing the past and are disturbed at the crude and cavalier approach to the difficulties of reconstructing historical reality characteristic of most sociology of this sort. And, unfortunately but inevitably, there are plenty of examples of a “historical” sociology that eschews any but the most superficial acquaintance with the past and with the tools of the historian’s trade, neglects (and even rejoices in an unconcern with) the difficulties and rewards of archival research, and blithely seeks either to cram the complexities of the past into a Procrustean bed of transhistorical “theory” or to reduce social reality to the banalities of lower mathematics, in the worst cases engaging in a little of both.

But if there are—all too often—ample grounds for the historian’s suspicion of the sociological imagination, there is also good reason for regret that this should be so. The distinction between the idiographic and the nomothetic, valuable enough if it refers to a tension embedded in all attempts to grapple with social reality and to the relative emphasis on the particular or the general to be found in any specific piece of scholarship, threatens to be quite pernicious if it is reified and taken to refer to a real opposition, a binary choice between two mutually exclusive approaches to the study of human society. To the contrary, while generalization based on third- or fourthhand acquaintance with historical reality (and often a superficial and highly selective encounter at that) raises grave questions about the ontological status of the proffered accounts, a resolute emphasis on the uniqueness of events, if taken at face value, simply dissolves into solipsism. Any attempt at description and explanation necessitates a resort to abstraction from the endless particularities of the individual case, a reliance on generalization and the use of analogy, and an explicit or implicit comparison of one set of events with another.

One may quite reasonably object to the grandiosity of much sociological generalization and to the absence of concern among all too many of its practitioners with the constraints and disciplines imposed by the richness of the historical record. One may sensibly take issue with the tendency to value, in Gusfield’s terms, the conclusions over the story, heedless of the epistemological difficulties—to say nothing of the empirical distortions and inaccuracies—that such a preference invites. But neither of these arguments confers exemption from the dilemma confronted by all practitioners of the historical and social disciplines: that the ceaseless flux of social reality can be ordered, however provisionally, only by means of reasoned thought and comparison. And this process must of necessity rely on principles of classification imposed upon rather than drawn from that reality.² Historians are as subject to this imperative as sociologists because, ultimately, the distinction between the two disciplines is by and large an artificial and unfortunate one, however, entrenched it has become over the years in institutional structures and no matter how skillfully it is now rationalized by the self-interests of academic guilds.

Undesirable as the separation of history and sociology may be, still it constitutes, as Durkheim would say, a social fact, with whose ramifications one must necessarily come to terms. Responding, as they must, to a variety of factors—pressures to maximize the perceived distinctiveness of one’s discipline; the consolidation and entrenchment, through the specialization and professionalization of scholarship, of different criteria for evaluating intellectual merit; and the parochialism of contemporary academic life, which tends to create powerful linkages between one’s nominal disciplinary affiliation and the type of work that is encouraged and recognized as legitimate—it should come as no surprise that historians and sociologists are frequently so much at odds, even (perhaps especially) when cultivating the same territory. But such squabbles are nonetheless regrettable, the more so since neither side possesses a monopoly of virtue.

Justifiably, historians complain that many sociologists neglect the first requisites of historical understanding. But in their eagerness to point out the motes in the eyes of the sociologists, they are all too ready to overlook the beams in their own. For a sensitivity to questions of evidence and inference must be combined with theoretical sophistication and vision, and understanding the particular necessarily depends on an ability to place one’s findings within a broadly comparative frame of reference. All too often historians shy away from making their theoretical assumptions and interpretive frameworks explicit and regard comparative statements with ill-concealed suspicion and distaste—as if attending to such matters might contaminate the attempt “to understand the past on its own terms.” To the contrary, this evasion leaves one’s criteria of selection and relevance underdeveloped and unself-conscious, hence unchallenged and ill thought through; and it constricts one’s vision, distorting the sense of perspective so as to leave in obscurity aspects of historical reality that acquire meaning only when placed in a larger contextual frame. The extent to which my own contributions to the history of psychiatry are distinctive is, I like to think, a result of my attempt to marry the traditional concerns of the historian and the sociologist: a willingness to do my historical homework, coupled with a concern with implicit or explicit comparison, with the more general significance of a given set of phenomena, and with issues that transcend the particularities of person and place.

Offering reflections on historical as well as contemporary issues, as I have done here and elsewhere, carries with it both risks and potential benefits. One’s position on contemporary dilemmas may, of course, contaminate one’s researches on the past, producing a narrow teleological history that abstracts both selectively and misleadingly from the record to provide a version of developments that neatly confirms one’s current political prejudices. Gerald Grob and Jacques Quen have been bitterly critical of “revisionist” historians of psychiatry (most especially of David Rothman) on precisely these grounds, and their objections are not to be minimized, even though they apply with equal or greater force to those using them as a cudgel pour epater les autres. For whatever Rothman’s deficiencies in this regard (an issue I discuss on occasion in other chapters), the much more common problem is precisely the reverse: the construction of versions of the past that serve (in ways generally obscured from those offering such accounts) to legitimate the activities of psychiatrists in the present.

This problem is scarcely unexpected, given that, until recently, much psychiatric history has been written by amateur historians, and a peculiar group of amateurs at that—psychiatrists themselves. Occasionally, as in the case of Richard Hunter an...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• List of Illustrations
• Chapter One: Reflections on the Historical Sociology of Psychiatry
• Chapter Two: Humanitarianism or Control? Some Observations on the Historiography of Anglo-American Psychiatry
• Chapter Three: The Domestication of Madness
• Chapter Four: Moral Treatment Reconsidered
• Chapter Five: The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic
• Chapter Six: From Madness to Mental Illness: Medical Men as Moral Entrepreneurs
• Chapter Seven: John Conolly: A Victorian Psychiatric Career
• Chapter Eight: Moral Architecture: The Victorian Lunatic Asylum
• Chapter Nine: Was Insanity Increasing?
• Chapter Ten: Progressive Dreams, Progressive Nightmares: Social Control in Twentieth-Century America
• Chapter Eleven: Dazeland
• Chapter Twelve: The Theory and Practice of Civil Commitment
• Chapter Thirteen: The Asylum as Community or the Community as Asylum: Paradoxes and Contradictions of Mental Health Care
• Bibliography
• Index