The Invisible Plague: The Rise of Mental Illness from 1750 to the Present (review)

Thirty years ago an American psychiatrist, E. Fuller Torrey, wrote a research paper suggesting that the current rates of functional psychosis (schizophrenia and manic-depressive illness) were not transhistorically constant, but rather a psychiatric side effect of advanced industrialization. For Torrey, government statistics over the previous two hundred years demonstrated a constant increase in the rates of the most severe mental disorders. Positing that these functional psychoses were "recent" diseases, he proceeded to identify possible biological culprits, including an as-yet-undetected virus circulating in industrial cities since the early nineteenth century. Apparently, the paper was rejected by every journal to which it was sent. The Invisible Plague is the author's book-length rebuttal to the skeptics who dismissed so long ago his "recent disease" hypothesis. Although contemporaries were divided over whether this reported increase was "apparent" or "real," most present-day scholars have eschewed any general acceptance of the possible rise in insanity, relegating it to cultural anxieties of Victorians and Edwardians worried about mental and physical degeneration. Torrey and Judy Miller, by contrast, believe this disregard to be unwarranted. We are, they believe, living amid an invisible plague—invisible because we refuse to acknowledge it.

Torrey and Miller dismiss one by one the series of explanations given by generations of historians and psychiatrists to the effect that there is no compelling evidence to conclude that insanity has been on the increase. First, although they acknowledge that the construction of asylums must have led to some families' "revealing" their insane members by (formally) confining them, this acknowledgment of mental illness, they argue, could not have happened decade after decade after decade: sooner or later, the attics would be empty of hitherto-sequestered family members. Second, they use nineteenth-century censuses (some of which listed "lunatics" and "idiots") in America and England to show that the Victorian returns in no way approximate the higher rates of mental illness found in the twentieth century. Third, they dismiss the idea that the psychiatric net has been cast wider, arguing that if anything, it was increasingly the more seriously (not the less-affected) mentally ill who found their way into institutions, for mental hospitals became overcrowded in the later nineteenth and early twentieth centuries. Fourth, they suggest that the increase in formal institutional accommodation could not be due to workhouses and poorhouses transferring the mad to mental hospitals, since these institutions continued to report insane residents in ever-greater numbers even when asylums were simultaneously bursting at the seams; indeed, they argue that, by the last decades of the nineteenth century, the asylums were desperately sending chronic insane inmates back to the poorhouses, a fact that still did not stabilize the numbers of officially reported insane in either type of institution. The only logical possibility, according to the authors, is to reject the prevailing and convenient historical assumption that the increase in insanity was no more than a statistical artifact or social construct, and accept that there has been an increase in the "real" rate of mental illness in the general population over the last two hundred years.

So why have generations of historians and psychiatrists been in collective denial about this "invisible plague"? The reasons are psychological, professional, and ideological. According to the authors, psychiatrists have not wanted to admit that they have largely failed to provide the cures they had promised for the last six generations. Thus professional prestige, and state-sanctioned monopoly, were and are at stake. Historians, we are informed, have been under the spell of a clutch of writers—namely, Foucault, Goffman, Laing, Rothman, and Scull—who have accepted Szasz's dictum of the "myth of mental illness." Thus historians, according to Torrey and Miller, have tried to understand the rise of the asylum solely as a response to changing social and cultural attitudes to "deviance"; they have not...