Madness: A Brief History (review)

When Roy Porter died at the age of fifty-five on 4 March 2002, the scholarly world and the general public suffered a grievous loss. Author and editor of about eighty books, he had a truly astonishing range of interests. His first book dealt with the history of geology, after which he turned his attention to eighteenth-century medical history and the history of psychiatry. But he never could be limited by period or subject. In 1994 he published a social history of London, which was followed three years later by The Greatest Benefit to Mankind: A Medical History of Humanity, a huge volume that spanned the centuries from the Greeks to the present. In many ways Porter was a catalyst; he always encouraged scholars to ask novel questions and to examine untraditional sources. His works on eighteenth-century medicine and his emphasis on the need to understand patients as well as physicians opened new horizons. His energy seemed boundless. Aside from his scholarly activities, he reached out to a broad audience through public lectures as well as radio and television broadcasts. His dynamic speaking style, combined with a healthy sense of humor and irony, only added to his appeal. Yet he never distorted his material or spoke down to his audience.

Madness: A Brief History appeared at just about the time of Porter's demise. In fewer than 50,000 words, he surveyed interpretations of madness from ancient times to the present. His synthetic abilities are evident throughout this brief volume, directed largely toward a general audience. The opening chapter surveys the debates dealing with the history of psychiatry since the 1960s. Porter contrasts the Whiggish interpretation so ably presented by Sir Aubrey Lewis with the challenges posed by such figures as Thomas Szasz and Michel Foucault. Rather than dealing directly with the heated debates that have taken place among historians of psychiatry, he focuses upon a few basic issues—namely, "who has been identified as mad? What has been thought to cause their condition? And, what action has been taken to cure or secure them?" (p. 9).

In the second chapter he describes the origin of the concept of madness as divine or demonic possession. Reformulated by Christianity, such beliefs persisted until the eighteenth century. The next two chapters trace the development of rationalistic and naturalistic thinking about madness in ancient Greece and Rome, and the literary and artistic interpretations of madness in the early modern period. Chapters 5 and 6 deal with the emergence of institutions for the insane and the creation of the specialty of psychiatry. In line with contemporary concerns with patients, Porter devotes a chapter to the perceptions and feelings of the mad. Chapter 8 covers what he calls "The Century of Psychoanalysis." At the present time, he notes in his conclusion, more individuals are purportedly suffering from a myriad of psychiatric syndromes; many are buying into psychiatric paradigms; a variety of therapists are competing for patients; and the use of psychiatric medications is widespread. "Yet public confidence in the psychiatric profession is low, as is evident from the ubiquitously distrustful images in the arts and reports in the popular press," he adds; "Is Folly jingling its bells once again?" (p. 218).

Historians of psychiatry will find that much of the material in this volume is familiar. Nonspecialists, undergraduate and graduate students, and a general literate public, on the other hand, will learn and benefit from this introduction to the history of madness. It provides valuable insights into an important subject that has been the object of scholarly inquiry for nearly half a century. Its nonjudgmental terminology, graceful style, judicious use of quotations, and breathtaking synthetic qualities make it a work that popularizes yet does not distort. Although Roy Porter died too young, he left behind a rich legacy that is symbolized by this small volume.