This book provokes new conversations about madness and its histories. In his 1987 book A Social History of Madness: The World Through the Eyes of the Insane, historian Roy Porter presented a powerful critique of psychiatry: he suggested that psychiatrists had effectively âexcommunicated the mad from human society, even when their own cries and complaints have been humanâ (Porter 1987, 233). Since Porter wrote, historians, governments, communities, psychiatric experts and the mad themselves have continued to ask questions about institutional care, psychiatric treatments and diagnoses, and about what it means to be mad. In the present, what we need is more dialogue: to listen, hear and engage across the borders of madness and its care, or what Porter termed âmadness and psychiatry talkingâ (Porter 1987, 8).
In this way, then, this book is part of a much longer public and scholarly discussion about madness. It takes selected evidence from different places across the international landscape of mental health following post-war institutional closures, but concentrates mostly on what we might term the British world, a site which has a shared history of mental health approaches, policy and practice. It presents short case studies from Britain, Australia, New Zealand and Canada to illustrate larger points about the impact of deinstitutionalisation on our thinking about madness in history (Kritsotaki et al. 2016, 6â7; 23). In doing so, this book signals the need for a more detailed transnational global story of mental illness, one that aims to connect the various interventions made into mental health care over time by mental health advocates, those with lived experience of madness, and professional experts interested in the mad themselves.
Continuing the provocation by Porter, and fashioned as a response to the growing international field of âmad studiesâ, this book provides a historical interpretation of the critique of the history of psychiatry over time. Mad studies are credited in recent times with bringing a âvoice of sanityâ to the field of psychiatry (Beresford 2014). Scholars interested in the field of mad studies have set out a new activist framework for the writing of histories of madness (see Mad Matters, LeFrançois, Menzies and Reaume, eds 2013). Mad Matters examines the field of mad studies from a range of disciplinary perspectives. It uses the idea of âmad peopleâs historyââa history prompted by the mad movement and legacies of anti-psychiatryâand it takes the theme of narratives, telling stories about sanity and madness. It also mounts a series of critiques of psychiatry, engaging with law, public policy and media, as well as with questions of social justice and identity politics. The editors assert that the field of mad studies offers both a new critical framework and an exercise in critical pedagogy, also circulating new knowledge and ideas about mental illness to contest regimes of âtruthâ (LeFrançois, Menzies and Reaume, eds 2013, 14).
Although this idea is faintly echoed in Andrew Scullâs weighty volume about madness, Madness in Civilisation (2015), Scull does not go far enough with his analysis of why, or how, madness needs to be rearticulated (see Coleborne 2017, 428). Porter was clearer about his efforts to retrieve the patientsâ voices in histories of medicine, and had offered several examples of the voices of the âmadâ in his many works of history. Porter suggested that he was keen to discover âwhat mad people meant to say, what was on their mindsâ (Porter 1987, 1). In a deftly argued chapter of his Brief History (2002), he suggested that influential histories of psychiatry had encouraged scholars to stop listening to the mad (157). The striving for some form of âobjectiveâ view of mental illness within the medical model led to a sharp breaking off from those asylum studies that were seeking to understand the circumstances of committal and the worlds of patients. All of this is supported by newer grassroots movements to engage survivors, mental health service consumers and users, and those with lived experiences such as the âHearing Voicesâ network in the UK, emerging from the 1980s, as well as World Health Organization (WHO) global mental health priorities in recent years.
One motivation for all of this work lies in redressing the problem of the profound silencing of the stories of mental illness by those who have experienced it, and the controlling effect of the powerful, monolithic institution of psychiatry and its asylums and hospitals that spanned the nineteenth and twentieth centuries. In her piece about silences and psychiatry, historian Diana Gittins writes that âNot just social groups, but also historical eras can become cloaked in silenceâ (1998b, 47). Silences shaped our understanding of institutions, their inhabitants, and their histories, until these were opened up to scrutiny, a process that was hastened by institutional closures. Gittins was writing about Severalls Hospital in Essex at the time of its closure in 1997, a closure running parallel to that of a New Zealand institution I have also examined, Tokanui Hospital in the Waikato region of the North Island. Both places were immersed in the worlds of their wider communities; they were significant in the lives of large numbers of people for almost the whole of the twentieth century. Their shared past also points to the profound influence of British psychiatry and its institutions on the former colonies, and the impact of imperial world concepts of medical and psychiatric treatment on British world populations, including the colonised.
As this book explains, New Zealand provides a useful point of difference in its approach to mental health policy, institutional closures, consumer advocacy and more, as well as its focus on positive MÄori mental health in recent years. The concept of âWhai Oraâ, or a âmeshing [of] MÄori values with Western medical treatmentâ, developed over time from a âcultural therapy unitâ at Tokanui Hospital in New Zealandâs North Island (Diamond 2005, 32; Durie 1994). Like New Zealand, both Australia and Canada suggest different nodes of the British world of mental health, inflected by common histories of colonisation, Indigenous peoplesâ experiences of psychiatric institutions and influences from both the Commonwealth and the Anglo-American world of psychiatric treatment. One original aspect of this book lies in its insistence on the value of considering perspectives from the histories of colonialism and madness, a theme that is highlighted in each chapter.
It is my view that the asylum was a social institution which created definitions and reflections of madness in place and space (Coleborne 2015, 7). In the 1960s, the French philosopher Michel Foucault argued that it was the institution of the asylum which brought insanity into view. He went as far as suggesting that âPerhaps some day we will no longer really know what madness was. Its face will have closed upon itself, no longer allowing us to decipher the traces it may have left behindâ (Foucault, trans. 1995, 290). The asylum was therefore much more than a building. It was a whole world, one with a hierarchy of staff, separate wards, corridors, farms and gardens, a system, where power was held by doctors and attendants. As Gittins (1998a) has noted, the âhome and harbourâ meaning of the asylum (27â28), was a space conceived at a particular time (3), for specific purposes and practices. Oliver Sacksâ elegant essay âThe Lost Virtues of the Asylumâ captures the ambivalent identity of an institution whose meanings changed over time: âwe forgot the benign aspects of asylums, or perhaps we felt we could no longer afford to pay for themâ (Sacks 2019 [2009], 192).
This institutional system also created official records required by law and imagined through medical practice. Records were administrative traces of knowledge about individuals who were confined for later generations of us to discover and puzzle over. These âblack marksâ of the institutional case notes of mental illness, as Foucault mused, might be its only evidence over timeâthe fact that it was written about, that the utterances and physical behaviours of the mad were recorded. The mad themselves had less power to write or recount their experiences, although many accounts are extant. On balance, it is apparent that the institution has held a deeply pronounced power to represent madness over time, as evidenced by the critique of the medical model of mental illness in the work of Thomas Szasz in The Myth of Mental Illness (Szasz 1961). This view was also espoused by the anti-psychiatry movement of 1964â1970s (Crossley 1998, 886). Later incarnations of anti-psychiatry have remained true to the call by prominent psychoanalyst and anti-psychiatry figure, R. D. Laing, to understand the nature of madness (Crossley and Crossley 2001, 1487).
Such institutional power has made the present task to find, disentangle and represent histories of patient experience, as well as stories of abuses and of institutional violence, very difficult. This goes for psychiatric survivors, mental health consumers, mental health service-users, and those with lived experience, as much as it goes for the historian or sociologist, or any researcher trying to reveal, expose or share such histories for public consumption. These terms are historically specific, part of a larger âmental health movementâ emerging in the twentieth century (Crossley and Crossley 2001, 1487). Such language is important, and speaks to the way that powerful identities have been forged through shared experience and a âprocess of struggleâ in the formation of a lived identity or habitus (Crossley and Crossley 2001, 1487). âPsychiatric survivorsâ is a descriptor given to people who railed against the locked institutions of the 1960s and 1970s, but who emerged as having survived the sometimes violent total institution; âsurvivorâ is a powerful term in the context of post-war recognition of the horrors of the Holocaust. The term retains its significance through current manifestations of movements such as #MeToo. Mental health âconsumersâ is a term made popular in the 1980s as health systems oriented around consumer needs and behaviours, a trend which also prompted new histories of âthe patientâ in the period. Mental health âservice-usersâ speaks to the idea that âconsumerâ is a loaded category; many people have used or accessed services without constituting themselves as having the freedom or agency of a private consumer. Most recently, âlived experienceâ denotes the broader sense of madness in our communities as experienced by those who may not have been hospitalised but who experience mental illness, and who may or may not access services or forms of treatment. These terms are used in this book in ways which speak to their specific historical contexts and meanings in place.
The practical and intellectual work to fully comprehend what it means to be mad is ongoing, and the political advocacy of and for the mad themselves now plays a central role in that work, as several chapters in this book explain. In addition, as scholars in the field also note, reclaiming the term âmadnessâ for this volume allows me to examine its meanings in the present, as well as gesture towards a continuity of experiences of the mad and institutionalised from the past. The book shows that those people experiencing mental illness, including some who were the former inhabitants of the large psychiatric institutions described in the proliferation of academic and institutional histories from the 1960s onwards, tell somewhat different stories from those who have often shaped official and academic histories of mental health, and it historicises these narratives.
The central argument of this book is that the stories from those with lived experience are vital to contemporary histories of mental health. Without such views or voices, histories of psychiatry and its treatments lose power and intelligibility. It was at the critical j...