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Book review: Madness; A Brief History, by Roy Porter

Updated: Jan 24

What are we to make of mental health? This is not a casual question. This month our newsletter has a strong focus on mental health for two reasons. The first is that mental health is being talked about more and more in society, but no one seems to quite pin down what they mean by this. Mental health can range from what is sometimes called low level anxiety, all the way to psychotic disorder. Secondly, mental health always seems to be talked about as if it is so debilitating that we lose sight of the human being.

To try and help us with this, we have a book review by Anna Clayton. Anna isn’t a mental health expert, and so we wanted to see what she made of the historian Roy Porter’s book ‘Madness; A Brief History’. Porter, a historian who specialised in the history of medicine seeks to introduce us to the tangled web of the history of mental illness. We place alongside this the voice of one of Britain’s greatest poets, John Clare. Clare wrote his poignant and ‘aching’ piece ‘I Am’, whilst in an asylum.

We hope that your minds are stimulated.

The Rev Ian Dewar Lead Chaplain, UHMBT

I Am!

By John Clare

I am—yet what I am none cares or knows;

My friends forsake me like a memory lost:

I am the self-consumer of my woes—

They rise and vanish in oblivious host,

Like shadows in love’s frenzied stifled throes

And yet I am, and live—like vapours tossed

Into the nothingness of scorn and noise,

Into the living sea of waking dreams,

Where there is neither sense of life or joys,

But the vast shipwreck of my life’s esteems;

Even the dearest that I loved the best

Are strange—nay, rather, stranger than the rest.

I long for scenes where man hath never trod

A place where woman never smiled or wept

There to abide with my Creator, God,

And sleep as I in childhood sweetly slept,

Untroubling and untroubled where I lie

The grass below—above the vaulted sky.

Madness; A Brief History, by Roy Porter

Review by Anna Clayton, FoodFutures coordinator

When the chaplain of your local hospital trust asks if you would read and review a book on madness over the Christmas period, only a sane person questions: what are they trying to say!?

Nevertheless I took up the challenge and put aside the novel on mythical creatures I had been saving up.

Being a complete and naive amateur when it comes to knowledge around 'madness' and different approaches to its treatment, it was somewhat of journey. One that I must admit only really scratched the surface and one that I would have to spend years reading through the extensive 'further reading' section to really get a good understanding.

In just over 200 pages Roy Porter's 'Madness; A Brief History' speeds through a wide range of different Western perspectives on mental illness, and who society has considered 'mad', alongside different approaches to treatment.

From mental illness being a domestic issue, where family members and a household would care or hide a person showing signs of 'madness'; it being considered the work of God, and the divine, and therefore handled by spiritual leaders; through to fashionable and creative forms of mental health conditions, and the rise and disintegration of institutions that housed and treated society's ‘mad’.

It was fascinating, although somewhat academic and slightly disappointing to not have considered Eastern perspectives, or anthropogenic causes of mental illness. Perhaps there is need for Madness: A Brief Eastern History?

The book starts in antiquity and the last pages end up reflecting on our present day situation. As a result it explores a vast range of patients and their treatments: “From electric shock therapy to sexual deviancy, witches to creative geniuses, and psychoanalysis to Prozac…”

As the book often questions, there are many moments when you have to question who is more mad: the patient or woman accused of being a witch, or the person inflicting the treatment. The chapter on 'the mad' where the voices of those housed in madhouses are shared particularly stays with me as do the following quotes:

“The Scot Cheyne identified his ‘English Malady’, a form of depression, as the disorder of the elite in an advanced, prosperous, competitive nation: the pursuit of affluence, novelty and elegance, and the moment of the good life – excessive eating and drinking – exacted a heavy toll”. Page 83

“In urbanised Europe, and in North America, the rise of the asylum is better seen not as an act of state but as the side effect of commercial and professional society…In England around 1800, the confined were mainly largely housed in private asylums, operating for profit in the market economy in what was frank terms the ‘trade in lunacy’”. Page 95.

As the book concludes: “More people seem to be diagnosed with suffering from more psychiatric disorders than ever” and we have got great at “pacifying patients with drugs”… “this hardly seems like the pinnacle of achievement...”

The next book on my reading list – Cannibal Capitalism - certainly feels like a relevant next read.

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