The Politics of Madness: The State, Insanity and Society in England, 1845–1914 (review)

Although a vibrant field of research, the history of psychiatry has also been marked by conflict if not irreconcilable differences. The older approach was to emphasize the writings of psychiatrists and the institutions over which they presided. Beginning in the 1960s the focus began to shift. Scholars emphasized instead the rise of the asylum, the manner in which individuals were institutionalized, the role of class, gender, and marital status, as well as the professionalization of psychiatry and the manner in which practitioners shaped institutional character. Indeed, both the specialty and the institutions in which its members practiced were generally placed outside a traditional medical framework. In its most extreme form, scholars suggested that the new psychiatry reflected the rise of medical entrepreneurs within the commercialized labor markets of the nineteenth century. The role of the asylum was neither curative nor custodial; it was designed to transform nonproductive individuals and reshape their behavior to conform to the norms of rational bourgeois morality.

More recently the attention of scholars has shifted away from macroin-terpretations to more microoriented ones. In part this has been a function of the sources they employed. In addition to the writings of psychiatrists and medical documents, they studied a far broader array of sources, including commitment and patient records that provided data on the social, economic, and demographic characteristics of institutionalized patients. In The Politics of Madness Melling and Forsythe have examined the records of four English institutions. Their major focus is on the Devon County Pauper Lunatic Asylum in Exminster, which recorded more than 13,000 admissions between its opening in 1845 and 1914. But they have also studied two other pauper lunatic asylums erected in the later nineteenth century that served the boroughs of Exeter and Plymouth as well as the Wonford House Asylum, a private institution that charged fees.

In a brief review it is difficult to do justice to the complex and variegated analysis presented by Melling and Forsythe. Certainly their prodigious research in manuscript sources makes their book somewhat unique. Aside from patient records, they examined Certificates of Insanity and Magistrates’ Committal Orders, Minutes of Visiting Justices responsible for governance and general management of the asylums, as well as selected records of the Lunacy Commission, to say nothing about printed government records. Rejecting the monolithic interpretations advanced by Michel Foucault and Andrew Scull, they offer a far more sophisticated and sensitive analysis of the rise of the asylum and its subsequent evolution. They argue that the fate of the institutionalized could be understood in terms of “a complex politics of insanity” extending from the “high politics” of such central agencies as the “Lunacy Commission and Poor Law Board to the magistracy, Poor Law Unions, and County or Borough Councils which assumed responsibility for the interpretation and enforcement of the legislation” (206). Equally significant are their findings about the composition of those admitted to the asylum. To be sure, the Wonford House catered to a more affluent part of the Devon society. But those admitted to the public asylum were not the destitute occupants of workhouses or other marginal groups. On the contrary, the households from which they came were independent both prior to and even after the member was identified as a lunatic. Nor was there evidence of a gender bias in admissions even though the experiences of males and females within the asylum differed. They also concede that the geographical area they examined may not have been typical of other parts of England and that more research is required. These are but a few of their findings.

To be sure, reliance on quantitative analysis has some drawbacks. It is difficult, for example, to abstract the actual experiences of patients within the asylum; numbers tend to result in a quasi-dehumanization of the subject. That being said, there is no doubt that The Politics of Madness is a major...