Madness in America: Cultural and Medical Perceptions of Mental Illness before 1914 (review)

A broadly appealing yet scholarly history of psychiatry is a rare accomplishment. Art historian and curator Lynn Gamwell and historian of medicine Nancy Tomes have reached that ideal in their beautiful and gracefully written book, the first volume in the Cornell Series in the History of Psychiatry. Through lavish illustrations, vivid characterizations, and apt quotations from primary sources, Gamwell and Tomes have created a unique interdisciplinary contribution to the history of psychiatry.

Because of space limitations and, more important, a paucity of information, the book is limited to the “mainstream Anglo-American” (p. 7) tradition of psychiatry and to the mainly white patients treated in asylums, with brief sketches of African American and Native American modes of dealing with “madness.” That scope is large enough for Gamwell and Tomes’s comprehensive approach. The originality of their work lies in the combination of the social historian’s and the art historian’s knowledge and insights. Primary sources, most notably visual ones, are interwoven with a contextual history of perceptions of insanity and the treatment of the insane in American hospitals before 1914. A general history of psychiatry and madness is extensively illustrated by case histories of individual patients, excerpts from their literary efforts, photographs of paraphernalia used in mental hospitals for both treatment and restraint, and numerous reproductions of drawings, paintings, cartoons, and photographs by and about the mentally ill. The result is an effective blend of popular, political, aesthetic, and medical perspectives on madness from the eighteenth century to the First World War.

The very uniqueness of Gamwell and Tomes’s approach, however, leads to a somewhat misleading impression of mental illness. The visual evidence, the focus on individual patients, and the long captions accompanying some of the illustrations throw into relief unusually colorful or articulate or prominent patients. This stress on the uncommon or spectacular characterized much of nineteenth-century psychiatric literature, since “curing” strange, violent, and volatile patients presumably proved the success and value of hospital treatment. And the popular press and literary works, by dwelling on the sensational and the extraordinary, perpetuated public fears, prejudices, and misunderstanding. Actually, the vast majority of mental patients were seldom so interesting or colorful or productive: they were mostly silent, inchoate, and often unrelievedly unhappy. On the other hand it is true that some patients with special skills did remarkable things and thus revealed their kinship with humanity, not with the “tiger, the bull, and the enraged dog” (p. 32, quotation from Benjamin Rush). The Utica State Hospital patients who edited a literary journal, The Opal, in the 1850s demonstrated that the mentally ill were not so different from sane people. The issue is one whose complications Gamwell and Tomes might have explicitly pointed up.

On the whole, though, Madness in America is free of the oversimplification and inaccuracy so common in popular books on the subject. I know of no other work that so effectively combines popular history and scholarly research on perceptions of mental illness, and does so in such an attractive and accessible way.