Madness to Mental Illness: A History of the Royal College of Psychiatrists (review)

In both Great Britain and the United States, the founding of mental hospitals in the nineteenth century was followed by the creation of organizations representing the medical superintendents of these institutions. In 1841, the Association of Medical Officers of Asylums and Hospitals for the Insane came into existence in the U.K.; it was followed three years later by the Association of Medical Superintendents of American Institutions for the Insane in the United States. These organizations underwent several name changes; the former eventually emerged as the Royal College of Psychiatrists, in 1972, and the latter as the American Psychiatric Association, in 1921. Both played significant roles in shaping patterns of care and treatment and in the evolution of public policy. In Madness to Mental Illness, Thomas Bewley—a highly regarded psychiatrist who served as President of the Royal College of Psychiatrists from 1984 to 1987—has attempted to provide a history of that body from its origins in the early nineteenth century to 2005.

Before providing a description and analysis of Bewley’s history, I should like to provide some general comments. For nearly half a century, the history of psychiatry has been a vibrant if contentious subject. Those who have ventured into this field have come from a variety of disciplines, including medical and social history, medicine (especially psychiatry), the social and behavioral sciences, and cultural and literary studies. The result has been twofold. First, there has been an outpouring of books and articles based on both printed and manuscript sources that has gone well beyond the older approach which made the history of psychiatry a history of enlightenment and progress. Secondly, there have been sharp and irreconcilable differences among those writing about the history of psychiatry. Debates have centered around a variety of issues. Were mental hospitals and psychiatrists serving as repressive instruments of social control? Was the failure of mental hospitals to live up to their promise a perennial concomitant of the human experience or the consequence of malevolent intentions? Were mental disorders socially constructed or did they have an existence of their own? Such debates, however fierce, have contributed to a richer understanding of mental disorders, public policy, and the role of psychiatry.

A history of the Royal College of Psychiatrists could have contributed in significant ways to our knowledge of the role of psychiatry. Unfortunately, Bewley’s book contributes little to the history of psychiatry. Its organization lacks coherence. The first seven chapters provide a history of organizational changes from 1841 to 2005. The second part deals with subjects such as research, education of medical students, physicians, nurses, publications, and finances. The absence of any sense of chronological developments makes the narrative difficult to follow. More important is the lack of context. Psychiatry and its professional organizations were part of a larger society and were never isolated from larger political, social, economic, and intellectual currents. Yet Bewley’s narrative is written without an awareness of context. Its lack of sophisticated analysis vitiates whatever virtues the book might have possessed.

Most troubling is the fact that the author seems totally unaware of the rich secondary literature dealing with the history of psychiatry that has been published in the past half century. A knowledge of the many contributions of scholars working in this field would have given him the means of creating a framework that would lead to a meaningful understanding of the role played by a professional organization. Writing within a historiographical vacuum, Bewley makes some odd statements. For example, he has a section on the masturbatory theory of insanity in the nineteenth century. By omitting all other theories, his implication is that this was the dominant theory. In reality, it was but a minor element. Indeed, nineteenth-century theories of mental illnesses were far more varied and sophisticated.

I am sorry to be so critical of Madness to Mental Illness. Precisely because of its controversial character, writing about the...