Mental Illness and Social Health

In Theaters of Madness, Benjamin Reiss examines liberal ideology, mental hospitals, and imagination in the early American republic. Their relationship was uncomfortable, because liberty was at issue. Attracted by "a time when the treatment of the insane was a central topic in cultural conversations about democracy, freedom, and modernity," Reiss describes an unsettled situation (p. 2). New therapies identified as "moral treatment" literally unchained the insane and acknowledged their "right to mental health" by means of cultural activities such as literary composition and drama (pp. 4, 5). The condition of cure, however, was mental submission "to the totalizing power of the institutional authorities" (p. 25). Reiss demonstrates that contemporaries were troubled by how indistinct freedom and restraint were for asylum patients. Were the inmates citizens or subjects, nurtured or brainwashed, protected or incarcerated? These were unavoidable questions for a rising democracy trying to respond to human differences. Today discussion has become "sporadic," in the sense that concern with medications and costs skirts cultural values (p. 2). Through historical investigation of literary works produced in and about antebellum asylums, Reiss encourages his readers to feel a healthy anxiety about how a liberal society understands the mentally ill—and itself, in the process.

Like every author, Reiss makes initial choices that affect his analysis. It is important to recognize the design of his book. Reiss's perspective is political, institutional, and textual. As a literary scholar, he explores society by studying words. He asks how the tense balance of sympathy and authority in asylum management conformed to American ideals of "reason, liberty, and justice" and how literature at times complicated, and at other times clarified, this complex situation (p. 165). Neither a psychological study of new views of the mind nor a full social history of the mentally ill, Theaters of Madness shows why progressive asylums were the era's favored response to insanity: they mirrored a larger quandary about the limits of freedom. By explaining mental illness using the terms of cultural relationships, such as normative behavior and deviance, Reiss can draw analogies between asylum patients and other subject peoples. All expose the democratic problem of unequal power. At the same time, his focus on the polity curtails inquiry into additional lenses on the history of mental illness offered by medicine and religion.

Previous scholars who, like Reiss, investigate early mental hospitals using questions of liberty and order reach no single conclusion about whether these institutions violated or enhanced democracy. In Madness and Civilization (1961), Michel Foucault makes the asylum a symbol of how Enlightenment republicanism handled the problem of social restraint. His influential study explains that post-revolutionary culture in the transatlantic world reconceived insanity as a medical disorder susceptible to self-control if treated methodically in secluded settings. On the surface, the new view promised inclusiveness, voluntarism, and progress in place of unashamed treatment of the mentally ill as criminals. But Foucault argues that asylums more deeply served to legitimate liberalism and endorse invisible forms of control.¹

Analysts who focus on America describe greater anxiety about freedom in the New World and more ambivalence about asylums. "Utopian" hopes for Jacksonian reform institutions arose equally from distress at the everyday disturbances of democracy and optimism about social engineering, according to David Rothman in The Discovery of the Asylum (1971, p. xix). The mix of love and fear of popular government lent a desperate tone to the work of rehabilitating the insane, because the task seemed emblematic of the republic's capacity for self-correction overall. Yet every cloistered body within the democracy was also suspect as a subversive agent, as David Brion Davis explains in a key essay, "Some Themes of Counter-Subversion" (Davis, From Homicide to Slavery, 1986). Karen Halttunen adds, in "Gothic Mystery and the Birth of the Asylum" (Moral Problems in American Life, ed. Halttunen and Lewis Perry, 1998), that popular narratives of entrapment and liberation written by former asylum patients resembled expos...