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Common Knowledge 10.1 (2004) 158
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Ian Hacking, Mad Travelers: Reflections on the Reality of Transient Mental Illnesses (Cambridge: Harvard University Press, 2002), 239 pp.
The reissue in paper of this delightful volume of four philosophical-historical lectures and their copious notes (along with three appendixes), five years after its original publication, affords an opportunity to revisit perennial questions of whether mental illness is real and how diagnoses relate to reality. Pursuing his interests in multiple personality and using an epidemic (1887-1909) of fugue-travelers to illustrate the interplay of influences, Hacking puts forward the thesis that diagnoses, not only diagnoses of mental illness, require an ecological niche to gain a footing. Diagnoses, in turn, affect what is seen and the way patients behave, just as theories in general both focus and limit observation. Although the historical data are new and the presentation brings a wealth of facts and analogies from an astonishingly wide range of sources, the ideas seem familiar. Some fifty years ago, Walther Riese spelled out a simple but profound view of multiple approaches to diagnosis, also based on the historical and philosophical tradition, in The Conception of Disease: Its History, Its Versions, and Its Nature (1953). Where Riese outlined multiple approaches to nosology, Hacking emphasizes the causes and effects of diagnosis. The volume under review remains tantalizingly superficial, however. For all that he helps us find a useful approach to the reality of diagnoses, and for all that he tells us about the behavior of patients and doctors, Hacking does not address the mysteries of consciousness, memory, and motivation that animate the subjects of this book.
Anton O. KrisM.D., training and supervising analyst at the Boston Psychoanalytic Institute, is the author of Free Association: Method and Process. He is a member of the editorial boards of the Journal of the American Psychoanalytic Association and Psychoanalytic Quarterly.