“Drawing a hard-and-fast line between sanity and madness has always been a fraught business.”

This was a wonderfully put together book about the history of “madness.”

What is madness? Is it simply an outmoded word, only used to destroy patient dignity? Is it instead a defiant self-description in the face of modern psychiatric medicine? Whatever it might be to you, madness exists, and it continues to wreck human lives and communities as it has for millennia.

Andrew Scull briefly charts Western forays into treating the mad since the medieval period. In so many words Scull argues against Focault’s famous thesis, painting a picture of a long tug-of-war between community “care”, institutionalization, and the struggle to understand the incomprehensible. Scull follows the modern period particularly well, with a heavy skepticism I love, laying out at the end the real truth at hand: we just don’t know what causes mental illness—not really. Modern medications are helpful, but far from being the cure-all we’ve been told they are (and I’ve experienced). And without the moral and monetary infrastructure for a holistic long-term care model, what else can the system do but read a manual of symptoms and punch a new hole in you Certified-Mad Card? Why *are* we so over-diagnosed, and thus so over-medicated?

Perhaps the answer lies in the ruminations of earlier mad-doctors: We are humans with aberrations in thought, who deserve to be treated with respect and attempted to be understood. Sometimes those particular thought processes just don’t work with the society we live in. Sometimes we’re simply sensitive people who need a lot more help in navigating this world.

But then again, some of us see shadow people following us and wake up on rooftop buildings. So maybe get that prescription. (And watch out for tardive dyskinesia). ( )

Scull is a masterful guide to the complexities of madness and Western civilization's response to it. While he certainly is clear about his judgments of psychiatry's shortcomings, what is particularly refreshing about this book is that he does not approach it with the commitments to either psychoanalytic or biological approaches that have warped many historical accounts. His one commitment seems to be to the historian's fidelity to the complexity of the past. Highly recommended as a clear, compelling and nuanced brief introduction to the history of madness and psychiatry. ( )