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History in Focus

the guide to historical resources • Issue 3: Medical History •

Medical History

book jacket

Author's response


Masters of Bedlam: the Transformation of the Mad-Doctoring Trade

by Andrew Scull, Charlotte MacKenzie and Nicholas Hervey
Princeton University Press, 1996

Jonathan Andrews

I very much appreciate the opportunity to respond, on behalf of myself and my co-authors, to Jonathan Andrews' intelligent and searching review of our new book, Masters of Bedlam. Dr. Andrews is an unusually well-informed critic, and we are naturally delighted that his overall assessment of the book is so positive and laudatory. We hoped, in writing the book, to inspire other historians of science and medicine to reconsider the many virtues of a biographical approach, and thus are especially pleased with his conclusion that we have produced an "expansive and distinguished" and, "in the main...highly successful" volume that "should in many ways serve as a model for historians embarking on biographical studies of professional men, and more generally for anyone concerned with the ways in which individuals both impacted on and reflected wider historical patterns and changes."

At the risk of seeming churlish in the face of what is essentially a highly complimentary review, I would like to take issue, however, with some of the points Dr. Andrews makes in the body of his discussion. Some of these are issues where reasonable differences of opinion exist, and where I would like to elaborate on the reasons for the stance we have taken and the choices we have made. Some are places where I think Dr. Andrews has misrepresented or misconstrued our argument. And finally, a handful are minor instances where we believe that he himself has gone astray.

Let me begin with the particular choices we made about whom to discuss and dissect. We were acutely conscious of the fact that all the figures we discuss were members of the elite of the profession. This brought with it significant advantages, but also some drawbacks of a rather obvious sort: problems of representativeness; the sometimes radical differences of experiences, outlook, and options of the rank and file when contrasted with the top of the pile; and so forth. Our sense was that the benefits that flowed from a focus on the elite were far greater than the limitations this choice imposed; and that we could, with care, tease out the ways in which the individuals we wrote about reflected and revealed central aspects of the development of the profession as a whole, as well as the ways in which they were idiosyncratic and unrepresentative. Dr. Andrews' comments indicate that our decision on this front has been vindicated.

Andrews does raise objections, however, about some of the particular portraits we chose to draw. There were, of course, many more alienists whom we could have written about than we possibly had space for, even if we confined our attention to the professional elite. Men like Forbes Winslow and his son Lionel (once suspected of being Jack the Ripper), Thomas Clouston, Sir George Savage (Virgina Woolf's alienist), Daniel Hack Tuke, or Sir James Crichton Browne (W.A.F. Browne's son), will undoubtedly have their partisans, and in an ideal world, we would have included them too. (Indeed, I am seriously considering producing a second volume devoted to these and other figures for whom we did not have space on this occasion.) But we continue to believe that the choices we did make were both sensible and appropriate, allowing us to range widely across the entire century and to encompass a range of fascinating figures whose lives and careers together and separately provide a remarkable and engrossing entrée into the world of the mad-doctor. Haslam and Maudsley are clearly the leading figures at either end of the century, clever, controversial, and colourful, and by any measure central actors on this particular stage. Bucknill, as founding editor of the profession's official journal, co-author of the leading textbook in the field, and major spokesman for the profession, surely could not be ignored. And Sir Alexander Morison not only gave some semblance of academic respectability to the proto-profession through his annual series of lectures on insanity in London and Edinburgh, but also allowed us to explore the shadowy world of the non-asylum treatment of the insane - reminding us that even at the apogée of asylumdom an older tradition of treatment persisted, one with much greater ties to general medicine.

It is our other choices that draw Dr. Andrews' fire, however: Conolly and Browne because (as we acknowledge in the book) substantial portions of the chapters in question have previously appeared in print; and Samuel Gaskell because of doubts about his standing and significance. Let me address each of these criticisms in turn. To omit John Conolly from our cast of characters, given his centrality to the transformation of the profession and to its public standing in Victorian Britain, would have been like trying to stage Hamlet without the Prince. W.A.F. Browne is only marginally less important, whether one's focus is the achievement and limitations of lunacy reform, or the evolution of Scottish responses to insanity. Both men certainly belong in the book. Besides, though large portions of the Browne chapter had appeared in print before, as the introduction to a reprint edition of his monograph, the absurd and extortionate pricing policies of its publisher ensured that the book sold fewer than a hundred copies before being remaindered. Save for a small handful of specialists, therefore, few will have encountered this chapter's prior incarnation. Both chapters, moreover, contain some significant new material: on Browne's machinations, for example, to secure the post of Lunacy Commissioner for Scotland, and his fraught relations with the American lunacy reformer, Dorothea Dix (discussions deriving from a serendipitous discovery of manuscript materials at Harvard's Houghton Library), and on his overt materialism and radicalism as an Edinburgh University student, and the lessons he drew from the reactions this provoked; a much fuller account of Conolly's failed venture as a Professor of Medicine at University College London, placed in the context of the medical politics of the age, and noting his bitter relations with Thomas Wakley, later one of his major supporters in the crusade for non-restraint; as well as further details about Conolly's years of provincial exile and his failed efforts in behalf of his feckless and burdensome son.

As for Samuel Gaskell and his importance, Andrews and I simply disagree, and readers will have to judge for themselves which of us is correct. The derivative character of Gaskell's ideas about insanity is beyond question, but absence of intellectual originality may tell us little about the larger significance of someone's career. Gaskell was an unusually dedicated and effective asylum administrator, dealing heroically with appalling difficult challenges during his time as superintendent of the Lancaster County Asylum. He has much to teach us about the spread of the Conollyite orthodoxy through the expanding empire of asylumdom. At least equally important, however, is his crucial role in transforming the character of the central inspectorate, the Commissioners in Lunacy - establishing and defining the context within which his professional brethren operated; enforcing the legal constraints to which they were subjected; and accentuating the existing pressures to make alienism an essentially administrative specialty and asylums themselves a dull, protective environment, where merely keeping the patients alive became an end in itself. In all these respects, in my judgment, examining Samuel Gaskell's life and career provide us with unique insights into the development of psychiatry in the mid-Victorian age.

I turn now to some places where I think our argument has been misrepresented or misconstrued. In the first place, the chapter on Browne quite properly gives major attention to the origins and impact of his book, What Asylums Were, Are, and Ought to Be, the most important source of his reputation and influence. It is by no means the case, however, that the chapter is "mostly devoted to an analysis [of this text]." Discussion of the book occupies about a dozen of the chapter's thirty-nine pages. Almost as much space is devoted to a careful analysis of Browne's subsequent administration of the Crichton Royal Asylum. A variety of other topics, including his early education and career and his complicated relations with the Combes and with phrenology, are also addressed at some length. Nor do we ignore Browne's various other writings, apart from his book and his annual reports: his various pieces in the Phrenological Journal, the Journal of Mental Science, and the Medical Critic and Psychological Journal; his attacks in print and in private correspondence on proposals to reform Scottish lunacy law along the lines already established in England and Wales; his presidential address to the Medico-Psychological Association; and other attempts to defend his profession's prerogatives, are all drawn upon and discussed in more than passing fashion. On the other hand, we accept that more extended discussion of Browne's activities as a Lunacy Commissioner, as Andrews suggests, would perhaps have been warranted and would certainly be useful. If we elected not to venture down this pathway, the decision reflected a judgement that Browne neither enjoyed nor made much of the job; and our desire to defer analysis of what serving as part of the state inspectorate entailed to the chapter on Gaskell. Gaskell's service as a Lunacy Commissioner was of far greater import than Browne's, and the surviving sources on the former's performance in the role are by far the richer and more interesting of the two. In our view, moreover, Dr. Andrews' own forthcoming paper on the Scottish lunacy commissioners provides ample support for these conclusions: not only is he able to add remarkably little to our portrait of Browne's years as a commissioner, but his forced reliance on a very restricted range of source material (the commissioners' published reports and the minutes of their meetings) vividly demonstrates the very real limitations imposed by the nature of the surviving documents.

More broadly, and contrary to what Dr. Andrews implies in his review, we share his sense that the tendency of existing or nascent professions to seek to further and protect their own interests is entirely natural and in no sense necessarily disreputable (though I would add that careerism can be singularly unattractive in many contexts, and professional self-interest may, under certain circumstances, lead one to adopt positions at odds with the interests of one's nominal clients). Andrews accepts that we emphasize the limits to psychiatric power and self-interest, and acknowledges that overall, we "portray both the ambitions and the disappointments of [our] subjects with remarkable fairness, objectivity and insight." We give "credit where credit is due" and remain "appreciative of the complexities of personal motives, actions and career paths," presenting "no simple or linear picture of progression to repute and success..." Paradoxically, however, in almost the same breath he taxes us with ignoring "altruistic, or less selfish motivations" and of at least "intermittently" falling "into the trap of always seeking to unearth the darker, more egotistic sides of human conduct."

I leave aside the contradiction implicit in the claim that one intermittently always does something or other. I also leave aside the quite vital fact (which, to be fair, Dr. Andrews acknowledges) that ours is an approach which is not centrally about good and bad intentions, but rather one that argues that we must view the interaction of the individual and the social in a much broader, more complex fashion. Regardless, intent and motivation are transparently important matters. Do we in fact fail to acknowledge the dedication and self-sacrifice of at least some of our subjects? I think the answer is clearly no. We place great emphasis, for example, on Gaskell's herculean efforts in behalf of his pauper patients at Lancaster. We speak of the "characteristic vigour and determination" with which he attacked the appalling conditions he found on assuming his post at the asylum, and of his entire career as "the joint product of intellect and unremitting effort." His efforts to transform the very fabric of the overcrowded, prison-like facility he inherited are repeatedly praised as costing him "enormous time and labour." We note his refusal to be intimidated by the magnitude of the task, and we emphasize that he "provided a more humane and caring environment than most lunatics would have found in either the workhouse or the community..." Likewise in discussing Alexander Morison's solicitous regard for his patients, we provide considerable evidence of his dedication to their welfare, and the lengths to which he was prepared to go in accommodating their peculiarities and needs, even to the extent of "engag[ing] lodgings for patients and ensur[ing] that the physical environment in them was suitable to their circumstances." And we praise Browne as a "very talented administrator" devoted to his patients, someone who "took advantage of the considerable resources at his disposal [to enrich their lives] in a variety of imaginative ways."

To be sure, we take great pains to delineate the limitations of each man's vision, their blind-spots, and the unintended consequences of their actions. But to assert that we "always" emphasize "the darker, egotistical side" of these men's conduct is patently untrue. That said, I wait with bated breath for portraits of John Haslam and Henry Maudsley as men filled with the milk of human kindness. In these instances, our presentations are indeed rendered in darker (though not un-nuanced) hues, as befits the character of those we are writing about. The point is, our seven subjects are markedly different, in these as in other respects, and we have done our best to capture that individuality, warts and all. Nor, in my view, is it fair to say that we ignore the role of "chance, experience,... [or] adjustment to circumstances and wider forces of change." To the contrary, we emphasize the role of chance in, for example, such basic matters as Maudsley's entry into the profession in the first place, and John Conolly's even being given a second opportunity to obtain the superintendency at Hanwell. Experience, likewise, assuredly has its place in the stories we tell - we show, for instance, how it helps to account for Browne's changing estimate of the asylum's capacity to cure, and for Bucknill's growing emphasis on the feasibility and desirability of non-asylum treatment. As for "adjustment to circumstances and wider forces of change," so far from being overlooked, these are surely some of the central themes of the book, to which we return again and again. In the very first chapter, I lay out how essential it is to consider such interactions. "We take seriously," I stress,

the contention that people make their own history...But we are equally aware that human action is always constrained by and responsive to the wider social and cultural context within which it occurs. In examining the constant interplay between structure and agency, we necessarily confront the inherently interactive and collective dimensions of each individual's life. Paradoxically, therefore, the very endeavour to capture what it is particular and idiosyncratic about a given actor simultaneously requires us to attend most closely to the realm of the social. (p. 4)

Earlier in his review, Andrews praises Masters of Bedlam precisely for achieving these aims: "the apparent concern to...knit individuals to their contexts...works beautifully to place mad-doctors' careers in the setting of macro and exogenous shifts - including the 'rise of professional society'; the increasing role of the central state in lunacy provision; and the growth of a capitalist marketplace for medical and all other kinds of services." How, then, can it possibly be the case that we "neglect" or simply fail to credit the role of context and circumstance in understanding our subjects' lives and the choices they made?

Turning now to some of Dr. Andrews' more minor quibbles, we acknowledge that our footnotes are, indeed, quite extensive, and are vehicles for some extended commentary on points made in the text. Some, Dr. Andrews included, may find these discussions "self-indulgent." Others, I suspect and hope, will find them valuable and illuminating, both in extending and adding nuance to the basic argument made in the text, and in guiding the reader to relevant source materials. I think this is a matter about which we may reasonably disagree, and of which, of course, the final arbiter will be other readers.

Less legitimate, in my view, are Dr. Andrews' comments on our concluding remarks. His criticisms here, I suggest, rest on a distorted view of what actually appears in the text. First, notwithstanding my recent purported "preoccupation," the reader will search in vain for extraneous commentary on the subject of the history of somatic treatments in psychiatry. It simply isn't there. As for "incongruously moving off into a whole new digression on the subject of Freud and psychoanalysis," the reference is to a handful of sentences (amounting to less than a page) where I discuss a paradox of transparent significance: the intense resistance among the intellectual leaders of Edwardian psychiatry to a set of ideas and techniques of possible utility to those seeking to treat the still-functioning, albeit symptom-bearing patients who could form the basis for an office-based practice; and their stubborn adherence instead to somatic and degenerative accounts of madness, even though this obduracy meant that they remained impotent to elucidate the ailments they examined and all-but-incapable of intervening in any practical way in the course of these disorders. So far from being "strained," the relevance of this discussion is in my view self-evident. As for those who aspired to join the profession's elite choosing to leave behind the institutional sector as they rose to prominence, this is a pattern visible in the careers of not just Maudsley and Bucknill, but also such figures as Crichton-Browne, Savage, Blandford, and Lockhart Robertson. I continue to believe that the evidence supports our claim that such men "all too frequently were then led to adopt intellectual positions that put them at odds with the interests and outlook of the rank and file" [note that Andrews misleadingly omits the important qualification "all too frequently" when he quotes this passage]; and that "in word and deed, many of them proceeded to undermine the legitimacy of the very institutions that had given birth to medical psychology as a distinctive enterprise..." This is not a trivial point, since it helps us to understand why even in the early twentieth century, "mad-doctoring transformed...remained a handicapped and stigmatized enterprise - handicapped not just by the limitations of its own knowledge and capacities, but also by its own internal divisions..."

While rejecting these criticisms, however, I must acknowledge and apologize for the handful of typographical errors Dr. Andrews points to. "Humoural" is the product of an American copy-editor unfamiliar with the vagaries of British orthography, and "Doury" for "Drury" an obvious but unfortunate slip. The complaints about scanning errors are not always well-warranted, though: Dr. Charlesworth is identified (in one of the footnotes Dr. Andrews regards as self-indulgent) as a visiting physician at the Lincoln Asylum; and as for Haslam being originally housed within the hospital and subsequently "living at a considerable distance," this discrepancy is carefully explained in the text, his relocation being forced by the partial collapse of the hospital's buildings. Dr. Andrews must somehow have missed the relevant passage on p. 19. And though he credits us with examining the lives of three Scots and four Englishmen, the actual totals are two (Browne and Morison) and five (Haslam, Conolly, Gaskell, Bucknill, and Maudsley) respectively.

Before concluding, there is one final issue I would like to raise, because it so frequently features in reviews of my work in historical journals. I have been contributing to the history of psychiatry for more than a quarter century now. At the risk of seeming immodest, I think it is fair to claim that my work has been quite influential in historical circles, and I would like to believe that my commitment to the historian's craft had been established a long time ago. Nonetheless, virtually every time a historian reviews my scholarship, s/he seems compelled to allude to or make an issue of my background as a sociologist. Jonathan Andrews' review is no exception to this generalization.

At the risk of seeming thin-skinned, I have to confess that I find this tiresome. Nor do I think it is accidental. Sociologists do not have a good name among many historians, very often with good reason. I pride myself, however, on doing my historical homework and on accepting the discipline (forgive the pun) required to produce worthwhile historical scholarship. Hence, my annoyance at the persistent sniping of disciplinary border guards, which is all the more intense because the distinction between the two disciplines which I practice strikes me as by and large an artificial and an unfortunate one - however entrenched it has become in institutional structures over the years, and no matter how skillfully it is now rationalized by the self-interests of academic guilds. The study of human beings and human societies requires us to transcend the artificial boundaries that threaten to limit and distort our understanding, not to embrace or reinforce them. In my view, therefore, there is nothing odd or noteworthy about someone with my particular intellectual background interesting himself in or writing biography (as I have done for more than a decade and a half now). And I have good grounds for thinking that my position on these matters is not unique or idiosyncratic. After all, sitting in the next office as I write this response is my close friend and fellow member of the University of California, San Diego sociology department, Steven Shapin - someone else who trespasses regularly over the Berlin Wall dividing history and sociology; and someone else who has embraced a biographical approach in his own researches a not-insignificant fraction of the time.

Andrew Scull

March 1997

Original review

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