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Madness is a layman’s term for what psychiatrists and medical professionals call mental illness or psychiatric disorder. A mad person is characterized by psychopathology of one kind or another: a disordered mind, irrational or unintelligible behavior, extreme mood swings, disturbed emotions, bouts of anxiety, or a dysfunctional personality. Madness and mental illness are terms that are both distinct from ”insanity,” which is a legal concept. If a mentally disturbed individual comes before a court of law, the concern is whether he or she is insane (i.e., knew right from wrong, poses a danger to self or others, and/or is responsible for his or her actions).
Madness has been recognized throughout history in every known society. Primitive cultures turn to witch doctors or shamans to apply magic, herbal mixtures, or folk medicine to rid deranged persons of evil spirits or bizarre behavior. In ancient Israel it was widely believed that mental or emotional disturbances were caused by supernatural forces or an angry God as a punishment for sin or failure to follow the commandments. The Greeks replaced concepts of the supernatural with a secular view, insisting that afflictions of the mind were no different than diseases of the body. The Romans put forth the idea that strong emotions could lead to bodily ailments, the basis of today’s theory of psychosomatic illness. The Romans also embraced the notion of humane treatment for the mentally ill and codified into law the principle of insanity as a mitigation of responsibility for a criminal act.
During the Middle Ages, with the overriding influence of the Catholic Church, there was a return to the belief that supernatural forces, the Devil and witches were causing troubled mental states in people. During the Renaissance, with the rise of monarchies and state responsibility for the poor and disabled, there was a growing tendency to house mad men and women in special institutions. At century’s end, the abuses and sufferings of the mentally ill led to public outrage and a period of reform. A program of ”moral treatment” was begun – institutional care based on kindness, sympathy, guidance, work, and recreation – the reeducation of patients to behave normally. In the mid-nineteenth century there was the decline of moral treatment and the emergence of the ”medical model,” the perspective that stresses mental illness is caused by biological factors and is incurable.
The twentieth century is noted for the ascendancy of a variety of different concepts and treatments in psychiatry. In the 1920s the theories of Sigmund Freud on childhood psychosexual development and the unconscious mind profoundly affected psychiatric thinking and practice. The 1930s saw the introduction of electroconvulsive therapy, insulin treatment, and lobotomies. In the 1940s the war years uncovered a new disorder, ”battle fatigue,” while the post-war period, with the creation of the National Institute of Mental Health in the USA, saw the beginning of the federal government’s commitment to helping the mentally ill. In the USA during the 1950s the populations of state hospitals, growing for over a century, peaked and began a long period of decline. By the 1960s a ”psychiatric revolution” began, with an emphasis on recently developed psychoactive drugs to maintain patients both in and out of the hospital. De-institutionalization was public policy and became a social movement, complete with ideology and political action. At the end of the twentieth century the trend in institutionalization reversed again. Many former mental patients were returned to an expanding state hospital system as they could not be treated effectively in the community, were rejected by their families, or ended up on the streets of every major city, homeless and often in need of medical attention.
The second half of the twentieth century was marked with intense debate as to what madness is and whether hospital treatment is appropriate. Psychiatrists generally assume the presence of an abnormal condition in the individual which is manifested in specific symptomatology, but Thomas Szasz broke ranks and led the anti-psychiatry movement in the 1960s by arguing that mental illness is a myth, nothing more than ”problems of living.” Sociologists, on the other hand, tend to view mental illness as a label attached to persons who engage in certain types of deviant activities. Thomas Scheff, chief among them, argued that the symptoms and disturbed behavior typical of the mentally ill are more the conformity to a set of role expectations, products of situations, than the result of some personal predisposition or specific psychopathology. Walter Gove, however, argued that from a psychiatric point of view hospitalization is thought of positively, as a site to both treat patients and shield them from the environment that is causing or contributing to their madness. The sociological position, articulated best by Erving Goffman, casts the mental hospital in a negative light, as a ”total institution” that stigmatizes the patient and reinforces the very behavior it is supposed to correct.
The coming of the twenty-first century has not seen the end of the centuries-old controversies surrounding madness in people and its consequences for society. The causes of mental illness are still largely unknown. Whether disorders of the mind are due to organic, genetic, and biological factors or the result of developmental and environmental influences is part of the larger longstanding battle between ”nature” and ”nurture” among medical and social scientists.
- Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Doubleday Anchor, New York.
- Gove, W. R. (1970) Societal reaction as an explanation of mental illness: an evaluation. American Sociological Review 35: 873-84.
- Scheff, T. J. (1966) Being Mentally Ill: A Sociological Theory. Aldine, Chicago, IL.
- Szasz, T. (1961) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper & Row, New York.