Obsession: A History, and: The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, and: Shyness: How Normal Behavior Became a Sickness, and: Bipolar Expeditions: Mania and Depression in American Culture (review)

Madness Studies

In the last few years, several books from the humanities and social sciences have developed a new approach to psychiatric critique, among them: Lennard Davis's Obsession: A History; Allan V. Horwitz and Jerome Wakefield's The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder; Christopher Lane's Shyness: How Normal Behavior Became a Sickness; and Emily Martin's Bipolar Expeditions: Mania and Depression in American Culture. Together these books represent the maturation of new genre: "madness studies." Previously, the most well-known form of psychiatric critique arose in the 1960s and was grouped under the term "anti-psychiatry." Anti-psychiatry scholarship was short-lived and began to wane by the early eighties, but critique of psychiatry did not end with anti-psychiatry. At that time, "madness studies" also began to emerge—a form of critique that addresses the pharmaceutically supported turn toward science in psychiatry. The four texts reviewed here show that this genre is now poised to have a pivotal impact on the cultural understanding of psychiatry.

1980 is a useful date for understanding recent transitions in psychiatry and psychiatric critique. In 1980, the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual (DSM-III). Leading psychiatrists at the time hailed the DSM-III as a revolutionary book that would lead "to a massive reorganization and modernization of psychiatric diagnosis."¹ Historian Edwin Shorter confirmed this theme years later when he argued that DSM-III signaled "a turning of the page on psychodynamics" and "a redirection of the discipline toward a scientific course."² This redirection brought a heightened emphasis on biomedical models and pharmacological interventions. It shifted the psychiatric gaze, particularly in out-patient settings, from psychoanalytically-framed unconscious conflicts and childhood traumas to biomedically-framed broken brains and chemical imbalances.

1980 also heralded the decline of anti-psychiatry because the DSM-III crafted an effective counter-response to these critiques. Anti-psychiatry writers, like Thomas Szasz, David Cooper, R. D. Laing, Thomas Scheff, and Erving Goffman, were a diverse group, but one thing they had in common (or at least were interpreted as having in common) was a kind of ideological critique. Anti-psychiatrists as a group argued that psychiatry was problematic because it represented a false consciousness (a socially constructed myth that distorted the truth of psychic life), and because it was an illegitimate form of social control and coercion. DSM-III pulled the sting out of both critiques by co-opting anti-psychiatry concerns and by providing a scientific solution. DSM-III developers agreed that the psychiatry of old was unreliable and could work as an illegitimate form of social control. Thus, they offered the new DSM-III, which they claimed would fix these problems by developing an operational, scientific classification system that assured both truth and legitimacy. Through this tactic, DSM-III developers successfully diverted anti-psychiatry arguments, and the energy of this wave of psychiatric critique began to dissipate.

The pharmaceutical industry played a pivotal role in this story, and 1980 marks a watershed moment for it, as well. Marcia Angell, former editor of the New England Journal of Medicine, points out that 1980 was the year the pharmaceutical industry transitioned from a good business to the colossus we know today. "From 1960 to 1980," she writes, "prescription drug sales were fairly static …. but from...