Insanity, Institutions and Society, 1800-1914: A Social History of Madness in Comparative Perspectiveed. Joseph Melling and Bill Forsythe
Routledge, London, 1999
ISBN-13: 978-0-41-518441-0; 328 pages, price £49.50
Anne BorsayUniversity of Wales, Lampeter
Anne Borsay has written a characteristically thoughtful and fair-minded review of Insanity, Institutions and Society which provides us with a perceptive reading of the essays and succeeds in raising important points for discussion. Dr. Borsay offers a careful analysis of the individual chapters and is generous in her discussion of the introductory survey as well as Andrew Scull's critical response to the volume. It is difficult to quarrel with her summary of the arguments presented or the limitations which are identified. She is complimentary about the quality of scholarship and the coherence of the text. There are four or five points of criticism to which a response may usefully be made. The first question concerns the reviewer's description of the essays as exercises in an 'empirical unpicking of Foucault and Scull' which indicates the 'strength of realism in British historiography.' Borsay goes on to note that such an attempt to verify the claims of the grand theorists of the 1960s-70s is irrelevant to the post-modernist critique since it is precisely against such positivistic claims that post-modernism is directed. A second and related criticism is that the essays fail to provide a careful guide to contemporary linguistic usage in psychiatry and the changes in the way that the insane were classified and registered during this period. Thirdly, Dr. Borsay suggests that the contributors have tended to exaggerate the 'room for manoeuvre' enjoyed by patients and their families. Fourthly, the micro studies of particular institutions in different countries at distinct moments do not culminate in a sustained discussion of class development or the impact of insanity treatment on class society. Finally, the stress upon the institutional process found in these essays has the affect of denying the individual identity of the individual and thereby suppressing the voice of the mad, an omission of particular significance in a period when abusive practices were certainly features of the asylum system that flourished in the nineteenth century.
These are important reservations which need to be taken seriously by any contributor. My own reading of the essays and their epistemological assumptions differs from that of Dr. Borsay in a number of respects. It would be accurate to claim that the contributors seek to focus the discussion on specific institutional processes and texts in their attempt to reconstruct the transactions which led to the admission, detention and discharge of individuals from asylums in the 'long nineteenth century'. There is also widespread scepticism in the essays about the claims made by Michel Foucault and Andrew Scull concerning the mentality of the mad doctors and the class functions of both the psychiatric profession and the asylum as a social institution during this period. This is very different from accepting the textual evidence produced by the asylum and the other state agencies of the period as neutral data on the insane. Indeed, the primary concern of the volume was to suggest that the construction of insanity was a social, political and intellectual transaction in which the documents generated bore the imprint of the different actors who were involved in the institutionalisation of those who were legally construed as the pauper insane. Only by the careful reading of such textual sources may we deconstruct the different meanings which were attached to insanity in history and register the complexities of an institutional process which was portrayed in ambivalent if not contradictory terms by Foucault and reduced to an elaboration of class relations in the pioneering scholarship of Scull. The concern of the contributors was to define a social context in which the neglected role of Poor Law officials, families, communities, racial and ethnic identities, gender and class ties could be made visible in a narrative which revealed the asylum as a terrain on which identities and interests remained contested rather than being merely contained or suffocated. The institution was itself part of a network of power in which the remained some scope for asymmetrical bargaining, resistance and collusion. Such an approach implies an understanding of power and human agency as well as textual criticism which is surely some distance from mere empiricism or historical realism? Where post-modernism fails is precisely in its abandonment of any responsibility for providing a context in which to read the text of insanity. Post-modernist and cultural history often provides little conception of social power beyond the empire of the intellectual.
This brings me to the second, third and fourth points raised by the review essay. Dr. Borsay is correct to note that there is comparatively little discussion of individual psychiatrists or even the vocabulary of psychiatry in the essays, though Akihito Suzuki and Hilary Marland do provide fairly detailed discussions of the changing language of British psychiatry whilst Waltraud Ernst and Shula Marks give us a sustained discussion of the colonial psychiatric regime in India and South Africa. It could be said in our defence that Victorian alienists have received more than their fair share of historical attention given the quality of their intellectual contribution, though it would be more accurate to claim that the main concern of the volume was to demonstrate the limited influence which even asylum superintendents had upon the making of insanity and the life of the lunatic during the nineteenth and early twentieth centuries. Dr. Borsay may be correct to object, as did Scull in his own contribution, that some of the essays give an exaggerated impression of the degree to which patients and their families could make in the face of professional and institutional power. Professor Scull also shares Dr. Borsay's concern that we lose the larger picture of class politics in the focus on specific institutions, though it must be acknowledged that we call for a more vivid social portrait of the insane and complain when careful qualitative case study and systematic quantitative analysis reveal the importance of ethnic, racial, gender, community and other identities in the depiction and treatment of madness. The essays on Wales, Scotland and Ireland reveal the significance of such features in the complexion of insanity within the United Kingdom. Such contributions do not deny the vital significance of social class but rather emphasise the diverse cultural meanings of class within the body politic.
The final criticism made of the volume is morally the most serious for any historian of insanity. For if the writers on the history of madness do not permit the insane a voice and the capacity to 'influence his or her self through interacting, positively or negatively, with the asylum environment', then we must join the ranks of those mad house keepers who could not learn the lessons of moral treatment. Dr. Borsay argues that a necessary corrective to the analysis of official records with which this volume is concerned must be an attempt at 'searching out the mad themselves'. Yet if we recall some of the literature and criticisms which Dr. Borsay herself cites, it becomes clear that all the historian can ever do is construct an impressionistic portrait of the insane from the textual and other materials which are to hand. It is, in my view, impossibly romantic to assume we can rescue the mad from the enormous condescension of their contemporaries and restore to them a voice that society denied. For 'the insane' do not form a coherent group outside of the constraints which society and its institutions lays upon them. To be insane is largely to be written about and in most cases to be written off. Very few fragments remain from the lives of poorer people in the eighteenth and nineteenth century and even fewer of the obscure mad. They should be used wherever they exist. The challenge, as the brilliant work of Michael MacDonald, Roy Porter and others have shown, is to find a method of reading the accounts left by physicians and institutions in such a way that the testimonies of friends, relatives, petty officials and even the individuals themselves begin to surface from the constricted world of the institutional record. This is the argument of the new institutionalist history of insanity which is represented in the volume reviewed.
The purpose of Insanity, Institutions and Society is to introduce readers to a fresh generation of research on the social history of madness. This new work challenges many of the conclusions reached in the seminal studies of insanity by Michel Foucault and Andrew Scull. The authors also seek to engage with the kind of post-modernist critique of historical practices which Anne Borsay has highlighted in her review. The distance between state provision and class relations forms one of the issues which current and future historians of the nineteenth century will want to explore further. Dr. Borsay's valuable comments indicate that we have succeeded in linking the discussion of the social construction of madness to a wider debate on the practice of social and cultural history. We are very grateful for this contribution.