Reprinted from Nature 416, 681 (2002)

Last words of a medical historian


Andrew Scull is in the Department of Sociology, University of California at San Diego, La Jolla, California 92093-0533, USA.

Madness: A Brief History
by Roy Porter
Oxford University Press: 2002. 192 pp. 11.99, $22


Roy Porter had a sense of fun and an accessible writing style that attracted a wide audience.

The sudden and unexpected death of Roy Porter in March robbed the English-speaking world of one of its most prolific, colourful and talented social historians and historians of medicine. In the course of little more than a quarter of a century, Porter produced a staggering amount of scholarship in a dizzying array of fields.

From the 1980s onwards, following his move from the University of Cambridge, UK, to what was then called the Wellcome Institute for the History of Medicine in London, he devoted a considerable portion of his apparently limitless energy to the history of medicine and the history of psychiatry. Early on he published primarily on topics relating to the period in which he was most at home, the eighteenth century, including a ground-breaking reinterpretation of madness in Enlightenment England (Mind-forg'd Manacles, Athlone, 1987). But in the last decade of his life he ranged far more broadly, producing, for example, a history of medicine from the Stone Age to the present that encompassed not just the dominant Western tradition, but also Arabic, Chinese and Indian medicine (The Greatest Benefit to Mankind, HarperCollins, 1997).

Madness is probably the last book Porter wrote I say probably, for he wrote almost as fast as most scholars read, and it is possible that there is another book still in production. This slim little volume displays several of his virtues as a historian: his wide reading, his prodigious memory, his extraordinary capacity for synthesis, his eye for an anecdote, and the sheer fun he took in telling a story and constructing a narrative. Porter was in many ways a populist, eager to reach a wide audience, and capable of attracting many readers with a witty, graceful and accessible prose style, albeit one that at times was over-addicted to alliteration, puns and wordplay. But he was also capable of serious original research, and was not afraid to advance new and thought-provoking reinterpretations of his subjects.

Readers will find little of that serious side in Madness. This is in large part a reflection of his goal in writing the book: to summarize, in a very brief compass indeed, what the historian can say about "who has been identified as mad? What has been thought to cause their condition? And, what action has been taken to cure or secure them?" Such an abbreviated list of questions obviously leaves many vital and fascinating issues wholly unaddressed: the place of madness in high and popular culture; the impact of mental illness on both families and the larger community; non-Western ideas about, and responses to, the insane; and the social functions of madness and psychiatry.

Even so, Porter's chosen remit is an enormous one, and it has to be said that he has been only partially successful, even on his own terms. 'Western' all too often turns out to mean the English experience writ large. He does make sporadic gestures towards an international and comparative focus. There are, for example, a few pages on the physician Philippe Pinel and the French Revolution, and the founder of modern neurology, Jean-Martin Charcot, and his hysterical circus; a stab at characterizing nineteenth-century German academic psychiatry and its reductionist insistence (based on little more than faith) that madness was brain disease; a nod at America's twentieth-century embrace of a bastardized Freudianism. But again and again, both the text and the handful of illustrations return to the ground Porter found most familiar: what the English have thought and done about the crazed from the Middle Ages to the present.

For the specialist, then, Madness will not be a book to savour, and for the general reader it represents only a very partial brief history, in more than one sense of the term. The book is, for the most part, a good read, and is easily digested in a single sitting. Perhaps its most useful contribution, however, may be to whet the appetite for more substantial fare, and here Porter's extended and thoughtful list of suggestions for further reading may prove to be this book's best feature.