Physiognomy and the Meaning of Expression in Nineteenth-Century Culture (review)

Jonathan Andrews and Andrew Scull have uncovered a rather unique source for the history of British "psychiatry": the 1766 casebook of John Munro (1715-91), the second of the Munros to "rule" Bedlam, the proverbial London asylum. Perhaps the longest serving medical family to dominate the British "mad trade," the Munros were the essential "mad doctors" in England from the eighteenth century through to the rise of the modern reformed asylum and beyond. The casebook has been reprinted in the authors' Customers and Patrons of the Mad-Trade (University of California Press, 2002).

The present volume presents a detailed and rather remarkable account of the rise of a professional class of "mad doctors" in England, and the struggles among them for dominance in a trade that in complex ways defined the age of "reason." Here Foucault was quite right—when the philosophers and politicians struggle with reason, the result is a heightened awareness of unreason. In an age of a "mad" king (George III), such metaphors become, as the authors illustrate, even more compelling.

This is a strong book in its material and its opinions. Beginning with an exemplary biography of John Munro, the authors argue for a necessary specificity of eighteenth-century ideas of madness in the evolving professional definition of the asylum doctor and owner. (For Munro was not only the unpaid head of Bethlem Asylum but also owned, often under cover, other private asylums for the moneyed classes.) In sketching the debates about the nature of madness, Andrews and Scull grapple with a progressive model of the development of ideas of madness in England dominant since the 1960s. The view (espoused by, among others, Klaus Doerner) is that Munro represented reaction and his opponent William Battie represented progress. Andrews and Scull show that both men's views are shaped by the political needs of their own professional position: they argue that neither is regressive or truly progressive, but both are essentially political.

The authors also make their case across the widest reach of the patient population. They examine "mad" religious fanatics in the context of Methodism and its rise to challenge the accepted model of religious expression. They look at the role of the nobles in a case of murder that was unsuccessfully argued as a case of insanity. They look at the economics of the "mad trade," and the problems of "notable" cases: an attempted regicide and the madness of the king. All of the cases reflect the political function of madness in England, a function very different from its role on the Continent. The case material presented is convincing in both its detail and its breadth.

One aside, reflecting my own interest in other liminal groups in the United Kingdom at the time: Munro's rules by which spectators were admitted to view the patients at Bedlam excluded "Jews on a Saturday" (p. 26). This should have keyed the authors to a more nuanced reading of Hogarth's 1762 engraving A Medley, which they use (pp. 90-91) as the most appropriate illustration for contemporary views of enthusiasm, Methodism, sexuality, and madness. Peeping in at the scene through a window is "a Mohammedan sporting a turban [who] gazes through the window calmly smoking his hookah, implying that even heathen religions seem rational and sagacious by comparison with this medley of sectarian and Catholic enthusiasms and superstitions" (p. 91). If one looks at the contemporary caricatures, one sees that this is not a Mohammedan but a "Maltese" Jew. In the caricatures of Peter Pry, for example, Jews are represented as Orientals by dressing them in turbans and "Oriental" dress. They are almost always depicted smoking. In looking in from...