- Mind Forg’d Manacles: A History of Madness in England from the Restoration to the Regency by Roy Porter
Athlone, 412 pp, £25.00, August 1987, ISBN 0 485 11324 4
- The Past and the Present Revisited by Lawrence Stone
Routledge, 440 pp, £19.95, October 1987, ISBN 0 7102 1253 4
- Sufferers and Healers: The Experience of Illness in 17th-Century England by Lucinda McCray Beier
Routledge, 314 pp, £30.00, December 1987, ISBN 0 7102 1053 1
- Illness and Self in Society by Claudine Herzlich and Janine Pierret, translated by Elborg Forster
Johns Hopkins, 271 pp, £20.25, January 1988, ISBN 0 8018 3228 4
- Medicine and Society in Wakefield and Huddersfield 1780-1870 by Hilary Marland
Cambridge, 503 pp, £40.00, September 1987, ISBN 0 521 32575 7
- A Social History of Madness: Stories of the Insane by Roy Porter
Weidenfeld, 261 pp, £14.95, October 1987, ISBN 0 297 79223 7
For nearly two centuries now, the treatment of the mad in Georgian England has been almost uniformly portrayed in the darkest hues. Nineteenth-century lunacy reformers pictured the preceding age as mired in ignorance and cruelty, conjuring up indelible images of monstrous madhouse-keepers beating their patients into submission, chaining them up like wild beasts in foul holding-pens filled with shit, straw and stench; of the callous, jeering crowd – urban sophisticates and country bumpkins alike – thronging to Bedlam in their thousands to view the splendid entertainment offered by the spectacle of the raging and raving mad. Generations of Whiggish historians, celebrating the Victorian asylum as a triumph of science over superstition, the very embodiment of an aroused moral consciousness, sang variations on the same theme, seizing on the passage from the madhouse to the mental hospital as decisive evidence of our progress towards ever greater enlightenment and heaping opprobrium on the benighted denizens of an earlier age.
This comforting collective mythology came under savage attack a generation ago, when Michel Foucault launched his sustained assault on the Enlightenment and its values by writing a revisionist history of madness and (Western) civilisation: a history that turned the Whigs on their heads and denounced ‘that gigantic moral imprisonment which we are in the habit of calling, doubtless by antiphrasis, the liberation of the insane by Pinel and Tuke’. In the ideological atmosphere of the late Sixties, such radical criticism attracted many adherents, even (strangely enough) among politicians and public policy-makers, who were determined, for very different reasons, to turf the mentally ill out of the barracks-like bins the Victorians had bequeathed us and to subject them to the tender mercies of ‘care’ in the community. Even among historians, Foucault’s polemic prompted a wholesale reassessment of reform, and though few embraced the full fury of his onslaught on the machinations of bourgeois Reason, little of the earlier complacency and optimism about the Victorian era survived.
None of this work fundamentally altered our view of the 18th century, however. Foucault himself had seen the Classical age as the first decisive step in Reason’s repression of Unreason. From his perspective, the period from the founding of the first Hôpital Général in 1656 to the events of 1789 was in essence the age of the Great Confinement, a movement which swept the idle and insane from the streets, severed their connections with society, and cast them into oblivion-an oblivion in which they were nonetheless compelled, lest they further offend bourgeois sensibilities, to work as a moral duty. Those whom Foucault influenced tended to concentrate their attention on the dramatic 19th-century changes in society’s responses to mental disorder, and to the extent that they cast their eyes back on the pre-reform era, saw little reason to dispute its unsavoury reputation. Even Michael MacDonald, whose splen did Mystical Bedlam used the casebooks of the astrological physician and divine Richard Napier to illuminate the mental world of the 17th century, and to suggest that mental alienation and distress might then have been dealt with in surprisingly sympathetic ways, joined in the chorus of condemnation of the ‘medical brutality’ which followed. ‘The 18th century,’ he confidently announced, ‘was a disaster for the insane.’
It is this long-standing consensus of reformers and Whigs, Foucauldians and Anglo-Saxon revisionists, which Roy Porter’s dazzlingly written Mind Forg’d Manacles aims to upset. Examining the ‘long 18th century’ from the Restoration to the Regency, he attempts to provide the first systematic account of the evolution of attitudes to-wards insanity; of the emergence of a medical discourse about madness; of changing social provision for the mad; and even of the experience of being insane, insofar as this can be reconstructed from the surviving writings of mad people themselves. The portrait of the 18th century as the psychiatric dark ages is, he suggests, a gross oversimplification, and in its place he seeks to provide a richer, more nuanced analysis, albeit one drawn almost exclusively from printed sources and from such secondary accounts of limited portions of this territory as we already possess. On the whole he succeeds admirably, and the vigour of his prose, his skills at synthesis and his ingenious use of the materials to hand make the book something of a tour de force. He may at times overreach himself in his desire to overturn the conventional ‘wisdom’, and not all his claims will withstand critical scrutiny, but these are comparatively small flaws which scarcely detract from the magnitude of his accomplishment.
Foucault is among the first of his targets – in some respects, too easy a mark. For the notion of a ‘Great Confinement’ applies poorly to England, where there was no substantial stateled move to confine the mad (or the poor, come to that) during the 17th or 18th century. Indeed, the management of madness on this side of the Channel remained ad hoc and un-systematic, with most madmen kept at home or left to roam the countryside, while that small fraction who were confined could generally be found in the small ‘madhouses’ which made up the newly-emerging private ‘trade in lunacy’. There was no English ‘exorcism’ of madness; no serious attempt to police pauper madmen (on the contrary, a sizeable fraction of the clientele of the new madhouses came from the affluent classes, necessarily so if the new entrepreneurial system was to flourish); and so far from attempting to inculcate bourgeois work habits, ‘what truly characterised’ life in the handful of 18th-century asylums ‘was idleness’.
Other demonologies of Georgian responses to madness postulate a benighted and brutal era, riddled with sadism; a period of therapeutic stagnation or even retrogression, in which a sympathetic therapeutic eclecticism that had earlier held sway was replaced by catastrophically cruel medico-scientistic and mechanical treatments. These notions, Porter successfully argues, are too one-sided. They fail to capture the diversity and confusion that actually characterised the 18th-century scene, and they distort and omit aspects of the changing social response to madness which cannot be assimilated to a Manichean world-view.
Madness, he insists, was for 18th-century Englishmen an extremely broad sociocultural category. Separately or simultaneously, its manifestations could be seen as medical, moral, religious or even satanic. It belonged to the body or the brain, or to the mind or the soul. It extended and ramified in all manner of directions, and its boundaries were vague and uncertain, disputed and negotiable. Between Bedlam madness and the fashionable vapours and melancholy, no clear-cut lines of demarcation could be drawn. It follows that one must recognise the heterogeneity of the responses such diversity drew, and rather than resorting to simplistic generalisations, one should try to map the resulting complexity.
Madness, Porter contends, ‘was a real presence in the popular mind long before psychiatry spelt independent professional expertise’. Our efforts to reconstruct these popular mentalités are hampered, of course, by the limitations of the evidence that has survived, by the fact, above all, that our access to folk beliefs is necessarily mediated through the productions of the literate élite. But the limitations are not decisive ones, and with due caution we can uncover a good deal. Fundamental to most 18th-century views of madness was the belief that the condition was transparent, visible to all who had occasion to view the lunatic: a notion to be sharply contested in the following century, once a professionalised psychiatry succeeded in establishing itself and sought to make the expert diagnostic gaze central to the identification of insanity. Equally widespread was the notion that insanity necessarily involved a disorder of the body – a psychosomaticism as common among the laity as in medical circles.
Tempting as it may be to attribute this insistence on a physical grounding for mental afflictions to the imperialistic activities of the medical profession, Porter demonstrates that patients were every bit as eager as practitioners to incorporate mental disturbance into the realm of the body. Nowhere is this more evident than among those afflicted with the vapours, the spleen, hypochondria and hysteria: that whole complex of mental imbalance and upset which became so fashionable in the 1720s and 1730s, and which George Cheyne christened ‘the English malady’. For sufferer as for healer, an organic condition was a real condition, not a mere maladie imaginaire. Moreover, as long as, ‘ “superstitious” causes and “magical” cures still had their popular currency,’ the thought that these ‘morbid distempers were monsters of disordered minds’ was a terrifying one, suggesting the possibility either of diabolical possession or of the subversion of the soul itself, and rendering doubtful any prospect of cure. Faced, on the one hand, with ridicule for malingering and, on the other, with fears for one’s immortal soul, small wonder that, for sufferers too, placing the blame on the body came to seem preferable.