Of all the projects launched at the inception of the Wellcome Institute for the History of Medicine, none, arguably, was more successful than the social history of madness and psychiatry. I still recall the excitement with which our generation greeted the three volumes of Anatomy of madness and Roy Porter's monographs, Mind-forg'd manacles and A social history of madness. Many built upon those pioneering contributions until the field of psychiatric history became so densely cultivated that newcomers as well as some old hands were in danger of losing their way. One yearned for a handy overview incorporating the new orientations, providing the essential information, but leaving out the detail and the jargon.
The late Roy Porter provided precisely that with one of his last and shortest books. This elegantly designed volume is not just the short guide to the history of madness we and our students have long needed but also, implicitly, a summing-up of the project which Porter and his colleagues had inaugurated more than two decades ago in London. “In such a short book, I have focused”, Porter explains, “on a few core questions: who has been identified as mad? What has been thought to cause their condition? And, what action has been taken to cure or secure them?” (p. 9). In its 200-odd compact pages, the book explores these questions with great learning and brio. Beginning with pre-modern attributions of insanity to “gods and demons”, Porter guides us through the complexities of Renaissance and Enlightenment medical speculations and their cultural contexts, not forgetting to illuminate relevant historiographic debates—that over Foucault's claims on the beginning of institutionalization, for instance. The most admirable thing about the book is the way it balances multiple themes. Nineteenth-century asylum-building is highlighted, but not at the expense of nineteenth-century efforts to explain mental disorders as brain disorders. The twentieth century, the so-called “psychiatric century” and, of course, the century of psychoanalysis, receives detailed attention, but the current intellectual and cultural status of psychiatry are not left unexamined. Porter is always urbane but never bland. The account of America's mid-twentieth-century lobotomy craze, for instance, appreciates all the pressures that psychiatry was under at the time but still exudes righteous indignation. Modern “cosmetic” psychopharmacology, again, is explored with considerable sympathy but the sheer pathos of our quest for chemical bliss is not obscured. Obviously, doctors, their theories and their practices, feature prominently in the book but Porter reserves some of his most deeply-felt passages for the opinions and experiences of mad people themselves.
It is remarkable how much information is packed into the pages of this tiny volume: sentences sum up entire episodes, parenthetical remarks sketch world-views, and even the captions to the skilfully chosen illustrations supplement the text. Although any reader with any interest in the subject would find this a clear, compassionate and witty introduction, experts alone will appreciate quite how comprehensive and generous it is—and how free of the ideological obsessions and jargon-laden prose that the recent historiography of psychiatry seems unable to transcend.
