Madness : A Brief History by Roy Porter
To ‘define true madness’—the speaker is Polonius, labouring, as ever, to be wittily wise— ‘what is’t but to be nothing else but mad?’ Shakespeare’s greybeard pedant hit the nail on the head this time: isn’t insanity the mystery of mysteries? Even professors of psychiatry hold the most surprising views on the subject they profess.
In a brace of books, The Myth of Menial Illness (1961) and The Manufacture of Madness (1970), Thomas Szasz, Professor of Psychiatry at Syracuse University (New York), denied there was any such thing as ‘mental illness’: it was not a fact of nature but a man-made ‘myth’. He explained further:
Psychiatry is conventionally defined as a medical speciality concerned with the diagnosis and treatment of mental diseases. I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience.
Why so? The reason was plain: ‘there is no such thing as “mental illness”
For Szasz, who has continued to uphold these opinions for the last forty years, menial illness is not a disease, whose nature is being elucidated by science; it is rather a myth, fabricated by psychiatrists for reasons of professional advancement and endorsed by society because it sanctions easy solutions for problem people.
Over the centuries, he alleges, medical men and their supporters have been involved in a self-serving ‘manufacture of madness’, by affixing psychiatric labels to people who are social pests, odd, or challenging. And in this orgy of stigmatization, organic psychiatrists have been no less to blame than Freud and his followers, whose invention of the Unconscious (Szasz alleges) breathed new life into defunct metaphysics of the mind and theologies of the soul.
All expectation of finding the aetiology of mental illness in body or mind—not to mention some Freudian underworld—is, in Szasz’s view, a category mistake or sheer bad faith: ‘mental illness’ and the ‘unconscious’ are but metaphors, and misleading ones at that. In reifying such loose talk, psychiatrists have either naively pictorialized the psyche or been complicit in shady professional imperialism, pretending to expertise they do not possess. In view of all this, standard approaches to insanity and its history are vitiated by hosts of illicit assumptions and questions nullposees.
Szasz has not been alone. Madness and, Civilization, which appeared in French in 1961, the work of the Paris historian of thought Michel Foucault, similarly argued that mental illness must be understood not as a natural fact but as a cultural construct, sustained by a grid of administrative and medico-psychiatric practices.
The history of madness properly written would thus be an account not of disease and its treatment but of questions of freedom and control, knowledge and power.