Madness in Civilization by Andrew Scull

I guess I should have read the full title of the book ... Madness in Civilization - A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine.

Yes that describes the book.  I was hoping (delude?) into thinking it would be more like my favorite one word history books, Salt, Cod, and would give more of a global, multinational national, or at least geographic summary of how various cultures regarded the "mad."  The book is heavily Western Civilization focused and the cultural aspect deals with art and poetry, not a sociological, immediate and extended family analysis or summary.

I wanted a historical reprise showing how families, tribes and towns deal with the mad.  At what point did abandonment or exile become succor and care?  How does a community change its group response based on the mad individual's behaviors?  Are the reclusive dealt with better than the accusatory?

Instead, I am left with an impression after 400 pages that the expedient response of hiding the mad away, whether to save a family's reputation or to protect a village from violence, was universally chosen.

Scull splits the mad early on into the melancholic and the maniac mad and one is left concluding that spectrum of behaviors may well be many more than one mental illness.  His history of how the behavioral aspects of syphilis were long in being identified and helped institutions at least properly categorize if not treat their patients.

I (compulsively?) dog-eared too many pages to reprise Scull's observations or interpretations so I will go directly to the book's last paragraph:

"...much of Western medicine embraced ... that madness had its roots in thee body ... at least for the most severe forms of mental aberration .. biology will not prove to play an important role in their genesis.  But will madness, that most solitary of afflictions and most social of maladies, be reducible at last to biology and nothing but biology? ... The social and cultural dimensions of mental disorders ... are unlikely ... to prove to be nothing more than epiphenomenal features of ... human experience"

There was a short article in the New York Times this past week about some research into the early onset or accelerated degeneration of the ends of chromosomes and a lack of adequate telomerase to repair them as a factor in mental illness.  Like a discovery that proteins building up in the brain was a cause of Alzheimer's, where will this finding lead?  Does it trigger Big Pharma to make synthetic telomerase or does it lead the medical community to a conclude it is a chronic disease that cannot be reversed or halted?

So I am questioning how best do humans care for someone they care for with "madness."  I have resolved that madness or mental illness is used too broadly (Scull's chapters on the evolution of the diagnostic manuals surely emphasizes that the more "diseases" identified, the more cures doctors and druggists need to work on.  Similarly, his perspective on the increased labeling of autism and attention deficit in children appalls me as a mother when there are centuries of parents who could modify family life and distract or engage a child who was a live wire or shrinking violet.

Finally, Scull does not discuss the most current sociological or at least common cultural pressures to accept behaviors that in days of old were considered "mad" or threatening to community morals.  If we define mental illness as thought patterns that deviate substantially from the "accepted norm," isn't it a person's brain rather than their physical features and hormones that is telling them what gender they are and/or whom they should mate with?  Are addictions and substance abuse in part a function of availability of misused chemicals?  Scull discounts the theory of prior centuries which in essence deemed madness as a consequence on the child for the sins of the father ... why is there no discussion about latter centuries, the present, where society is attempting to abolish the recognition of dissimilar or in fact, unique physical attributes and traits to the demise of genealogical heritage, yet minutely striating mental expressed phenomena to a point where almost everyone can be labeled as deviating from the "norm."  We will all be the same ... uniformly crazy.