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The Confinement of the Insane. International Perspectives, 1800-1965

Consultant Psychiatrist, Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, Scotland

Porter, R., Wright, D. (eds) Cambridge: Cambridge University Press, 2003, £50 hb, 371 pp., ISBN: 0-521-80206-7

When the great social historian Roy Porter died suddenly on 3 March 2002, he was, characteristically, in the midst of writing up numerous projects - many of which are now appearing in print. 2003 saw the publication of Flesh in the Age of Reason (Porter, 2003), his masterly account of the history of ideas about the self. This current volume is a multi-author survey of asylums throughout the world, which Porter co-edited with David Wright, a professor of the history of medicine in Ontario. Porter provides the introductory essay and outlines the intellectual debates that have raged in the history of psychiatry over previous decades.

These debates can be seen as evolving through the three classic stages of thesis, antithesis and synthesis. First, came the benign view of the asylum as a force for good in society. This was followed by the counter-view, associated with Foucault and Scull, which saw the growth of the asylum in a malign light. Far from being humane, it was cast by these ‘revisionist’ writers as a mechanism of social repression. Finally, there emerged the more recent view, based on empirical, archival research, which has found evidence of both care and coercion in society’s response to the mentally ill.

As Porter notes, much of the research has focused on Western Europe and North America. The attraction of this book is that it ranges much more widely, taking in Africa, India, Australia and South America. In his thoughtful chapter on psychiatry in Japan, Akihito Suzuki considers the dilemma that arises when judging mental health care outwith Europe and America. There is the danger that indigenous systems are evaluated in terms of how well they have ‘kept up’ with the supposed ‘centres of excellence’. Equally, there is the danger that local practice is romanticised and hailed as a triumphant riposte to the perceived failings of the West. As many of the authors in this volume demonstrate, psychiatric care has developed differently in response to the particular mix of outside and native influences found in individual countries. Thus, to take one example, we find that Nigeria created an innovative type of community care where patients went to stay with local people in exchange for helping with the work of the village.

This collection does have two major shortcomings, which are alluded to in the book. In the chapter on Canada, David Wright (and his colleagues) ask whether social historians have over-emphasised the importance of social and cultural factors in the evolution of psychiatric institutions and have ignored what Roth and Kroll have called ‘the reality of mental illness’. In fact, the work of historically-minded clinicians on such asylums as Ticehurst, the York Retreat, the Royal Edinburgh, and the Fife and Kinross, has repeatedly shown that asylum inmates suffered from recognisable psychiatric conditions and that these could not be simply dismissed as ‘social constructs’. Surprisingly, none of this work is mentioned. Secondly, as Patricia Prestwich observes in her chapter on asylums in Paris,‘it is important not to lose sight of the individual patient’. This volume almost completely ignores the voice of the inmate, which is curious, given that Porter was one of the foremost champions of seeing the history of insanity through the eyes of the patient. This omission makes the volume unbalanced. Too much of the book is given over to graphs and tables of asylum statistics, and we learn little about the experience of the men and women who passed through these grimly-fascinating institutions of the past.

References

PORTER, R., SCHAMA, S. (INTRODUCTION) (2003) Flesh in the Age of Reason (Allen Lane History Series). London: Allen Lane.

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