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The Unbearable Madness of Being

MADNESS IN AMERICA: Cultural and Medical Perceptions of Mental Illness Before 1914. By Lynn Gamwell and Nancy Tomes . Cornell University Press and Binghamton University Art Museum: 182 pp., $39.95

March 30, 1997|ANDREW SCULL | Andrew Scull is co-author of "Masters of Bedlam" (Princeton). He is a professor of sociology at UC San Diego

Earlier generations of Americans understandably viewed madness as a frightening and mysterious disorder, as we do. Its most extreme manifestations--wild ravings, perturbations of the senses, deep depressions--were profoundly disturbing and disruptive events. The mad appeared, by turns, terrifying and disgusting, impervious to correction and impossible to control, people whose behavior threatened symbolically and practically the fundamental principles of organized social life. Above and beyond their own suffering and the grave social and economic costs they imposed both on their families and on society at large, the mentally unbalanced constituted a perpetual and troubling reminder of the precariousness of the rule of reason.

The insane were thus a source of bewilderment, anguish and fear. Oddly enough, though, they were simultaneously the objects of fascination and fantasy. Perhaps the persistence of such complex and contradictory attitudes helps to account for the extraordinary variety of discourses on mental disorder that one can trace in all periods of American history. Certainly, it has provided Lynn Gamwell and Nancy Tomes with a rich and rewarding territory to explore and, by and large, they have made the most of the opportunity, producing an invaluable appraisal of lay and professional perceptions of mental illness in the 18th and 19th centuries.

"Madness in America" constitutes an impressive first installment of a new series of "Cornell Studies in the History of Psychiatry." It is first of all an extremely handsome volume; its multitude of illustrations (many of them in color) are superbly reproduced and carefully integrated with its double-columned text (though it would have been nice to have had an index of all these pictures, to help the reader to relocate a particular image). Squarely aimed at an audience of nonspecialists, the book is the product of a fruitful collaboration between Gamwell, who is an art historian and museum curator, and Tomes, who is a historian of medicine. It ranges broadly across both popular and elite culture. It explores the shifting opinions and practices of those charged with the treatment and confinement of the insane and seeks to capture the perspectives of those victimized by this protean disorder, both patients and their families.

Gamwell and Tomes originally intended to produce a volume that traced "the treatment practices of three parallel traditions: Native American, Anglo American, and African American." In practice, this ambitious goal proved impossible and for the most part (with occasional genuflections toward alternative traditions), they have focused their attention on mainstream white American medicine, which in this historical period means essentially asylum medicine. Within these generous confines, however, the authors have managed to unearth an evocative and wide-ranging array of material objects, often obscure or hitherto overlooked, which, taken together, provide an engrossing overview of a multifaceted and extremely complex history.

The book's images are by turns striking, distressing and poignant--even, on occasion, amusing. Typical is an array of pictures illustrating the extraordinary variety of techniques deployed to master the mad and perhaps restore them to some semblance of sanity. There are, of course, the chains, cuffs and straitjackets that remained a standard response to the threats posed by the raving and the suicidal; throughout the period Gamwell and Tomes survey, they are pictured in advertisements provided by their manufacturers and in collections preserved from a variety of asylums.

There are also more ingenious devices concocted by the mad-doctors to whom their care was entrusted: The "tranquilizer" invented by Benjamin Rush, one of the signatories of the Declaration of Independence and the most prominent physician of the Revolutionary War period, was a sturdy wooden chair fixed to the floor with devices to immobilize the patient's arms, legs and trunk, a headpiece to shut out light and sound and a commode to allow the trussed-up madman to relieve himself while confined. The Utica crib, invented at the New York State Lunatic Asylum at Utica, was a wooden contraption with a tightly fitting lid that kept the recalcitrant lunatic safely sequestered at night. Also pictured are the tubs to which patients were consigned to receive the benefits of "hydrotherapeutics," streams of hot and cold water that were directed to various parts of their anatomy. Other machines were devised in the late 19th century to deliver electric shocks and stimulate the nerves.

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