Mental Disorder in the Atlantic World

by

Leonard Smith

• LAST REVIEWED: 06 December 2022
• LAST MODIFIED: 28 November 2016
• DOI: 10.1093/obo/9780199730414-0216

Introduction

Mental disorder is a long recognized element of the human condition. Throughout history, the responses to madness have featured both condemnatory and sympathetic elements, leading to punitive measures, restrictive incarceration, or treatment with curative intent. Relatively enlightened approaches were becoming apparent in parts of Europe and the Middle East by the 16th century, notably in Spain. By the mid-18th century, the “madman” was no longer perceived generally as a wild beast that had to be tamed, but more as a person who had lost his reason and required restorative treatment. The principle became established that the achievement of recovery was most likely if the disorder was identified early and the deranged person removed from his or her normal surroundings to a specialist institution, where they could be managed and treated. Public lunatic hospitals, or asylums as they later became known, were established quite widely during the 18th century, particularly in Britain, where there were also growing numbers of private “madhouses.” Published writings on insanity multiplied and ideas on its origins and treatment became increasingly sophisticated, with psychological approaches gaining increasing prominence alongside the more traditional medically based techniques. Exposures by reformers of oppressive practices and harsh, insanitary conditions in some institutions aroused public opinion. The principles associated with “moral treatment” and “moral management” became increasingly influential on the new generations of state-sponsored lunatic asylums established in Britain, Europe, and America during the 19th century. Much benefit was anticipated from these institutions, but expectations gradually became disappointed. Rising populations, widening parameters of what constituted serious mental disorders, and the failure of many patients to recover sufficiently to be discharged, led to a steady rise in both the size and numbers of public lunatic asylums. A range of new problems and issues had to be addressed. Structures were needed to maintain order, discipline, and some semblance of therapeutic endeavor in large, often overcrowded, and increasingly impersonal institutions. The majority of works cited in this bibliography relate to Britain in the period up to the 1860s, which reflects both its prominent place and the level of attention given to British practices and institutions by historical scholars.

General Overviews

Historians have approached the subjects of mental disorder, its identification, treatment, and management, from a range of different perspectives, which might be construed variously as medical, descriptive, Whiggish, or ideological. In recent years, following the important influences of Foucault and Scull, there has been a marked reorientation toward the social, political, and cultural aspects of the history of mental disorder and its management. The medical approach, with an emphasis on the historical development of differentiated symptoms and pathologies, is exemplified by Berrios 1996. Gilman 1982 utilizes visual imagery to convey powerfully how perceptions of mental disorders and public responses to them have altered significantly over the course of several centuries. The authoritative study Porter 1987 concentrates mainly on the important developments in ideas and practices in England in the 18th-century. England is also the focus for the orthodox narrative of progress and reform since 1700 provided in Jones 1972. A more critically skeptical approach to similar historical passages is adopted in Scull 1981 and Scull 1993, while Scull 1989 goes beyond Britain and includes comparative consideration of developments in America. Foucault 2006 has been profoundly influential on both historians and a wider audience, although empirically established facts are sometimes overtaken by the intellectual sweep of the narrative.

• Berrios, German E. The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge, UK: Cambridge University Press, 1996.

  DOI: 10.1017/CBO9780511526725

  A volume intended primarily for reference by psychiatric clinicians. It identifies the contributions of early practitioners to the emerging delineations of symptomatology for the main mental disorders.

• Foucault, Michel. History of Madness. Translated by Jean Khalfa. London and New York: Routledge, 2006.

  English translation of Histoire de la folie à l’age classique, first published in 1961. The most satisfactory English translation of Foucault’s profoundly influential text, in which he critically surveys developing perceptions of madness, legal and institutional frameworks for incarceration, technologies of control, medical dominance, and the rise of the specialist lunatic asylum. (See also Ideas on Mental Disorder and Insanity).

• Gilman, Sander. Seeing the Insane: A Cultural History of Madness and Art in the Western World. New York and Chichester, UK: Wiley, 1982.

  This essential volume comprises visual representations of insanity from the 16th century onwards. Gilman provides a clear and concise explanatory narrative, locating the images within their artistic and historical contexts.

• Jones, Kathleen. A History of the Mental Health Services. London: Routledge and Kegan Paul, 1972.

  Focused on England from 1700, Jones provides an orthodox account of changing attitudes toward mental disorder, the development of public lunatic asylums, and the consolidation of a legal framework, with an emphasis on the key 19th-century reforms.

• Porter, Roy. Mind Forg’d Manacles; A History of Madness in England From the Restoration to the Regency. London: Athlone, 1987.

  The key text by Roy Porter, who was the foremost authority on mental disorder during the “long” 18th century. It locates insanity within its societal context, and considers the private and public institutions, the people, and the methods deployed to confront it.

• Scull, Andrew, ed. Madhouses, Mad-Doctors and Madmen: The Social History of Psychiatry in the Victorian Era. London: Athlone, 1981.

  Scull’s critical overview introduces a valuable collection of articles related to England. Topics include therapeutic developments, the influence of phrenology, the operation of an early county lunatic asylum, and the controversy surrounding alleged “wrongful confinement.”

• Scull, Andrew. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. London: Routledge, 1989.

  A collection of critical essays on subjects that include the domestication of insanity, “moral treatment,” asylum architecture, the changing roles of medical men, and the incidence of mental disorder.

• Scull, Andrew. The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900. New Haven, CT: Yale University Press, 1993.

  This extended revision of Museums of Madness (Scull 1979, cited under Institutional Studies) scopes the rise, growth, and eventual over-expansion of the British lunatic asylum system, highlighting the dynamics of “reform,” the professionalization of psychological medicine, and the widening parameters of mental disorder.