It All Began Here

Those who have watched the progression of my life over last five decades, will automatically assume that my most recent foray of trying to decode the nuances of the Madness and Civilization has the existential causal connection to my own life. But it is far from the truth. The truth beckons, I first got hooked to the subject matter of madness five and half decades ago in the winter of 1969, when I started reading the psychology book of my elder sister who had psychology as one of her subjects for her college examination.

Nonetheless, I turned into a serious researcher of the Madness and its History, rather accidently, four decades back, in 1983, when the Sixth Edition of James C. Coleman’s 800 pages long magna-carta titled “Abnormal Psychology and Modern Life” landed in my lap one summer evening in the ancient Indian city of Patliputra . It took three days for me to internalize the entire book and instant came the decision-psychology would be the second optional subject in the Indian Civil Services examination, in my quest to be an Indian civil servant (my forte was Mathematics , Physics and Statistics and not humanities). Psychology helped me become a member of Indian civil services tribe (railway-man to be precise) but more importantly with Coleman began my life long love story with the madness. It had stayed put as my cohort for life .

It will be appropriate then to say that I cut my teeth in the la-affaire madness in all its nuances including its history , at the alter of Coleman’s book, more particularly the Seventh Edition (1984) and thus began my journey to try to understand, internalize and unravel inner layers of the biology, neuro-pathology, psychosocial marker and sociological underpinnings of the madness.

The Seventh Edition (1984) of Coleman on its last two pages had inscribed in brief the DSM-III classification of madness ala mental disorders . Even today the book sits on my desk as i write this piece.

My jigyasha to decipher the history of madness, owes its debt to chapter one of the seventh edition of the Coleman book which briefly describes “views of the madness carried forward from the history and literature”

Twenty First Century as the Age of Madness

The opening paragraph of the 1984 editionn of the book “Abnormal Psychology and Modern Life”, says, the Seventeenth Century has been called the Age of Enlightenment , the Eighteenth, the Age of Reason; the Nineteenth the Age of Progress; and the Twentieth, the age of Anxiety. I humbly, posit that the right way do describe the Twenty First Century is not as the Age of Artificial Intelligence (AI) but as the Age of Madness, such has been the diagnostic inflation in the train of DSM -5 and DSM-TR

Indebted to Coleman

I carry the immense gratitude and the enormous debt to the treatise of Coleman’s book. When the Seventh Edition was published in 1984, the 494 pages long DSM–III (1980) that medicalized madness with explicit diagnostic criteria and a multiaxial diagnostic assessment system was becoming the accepted taxonomy for the classification of instances of madness in all its nuances. But it was the Coleman’s book which made me believe that the biological reductionism of the madness, is not the full story, and that there was, is and will remain strong interlinkages of madness with philosophy , psychology, sociology ,religion, spirituality , culture, anthropology jurisprudence and politics among many things.

A very brief introduction to James C. Coleman is in order at this stage because Coleman is an unknown commodity to the most Indians of this era. James C. Coleman Late Professor Emeritus at the University of California at Los Angles, when first published his first edition of the book Abnormal Psychology and Modern Life in 1950, the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-I) of American Psychiatric Association (APA) was still a work in progress. DSM-I would arrive two years later only in 1952

How impactful was the first edition of Coleman’s Abnormal Psychology and Modern Life, published in 1950. It is best described by what the famous American psychologist Meltzer, H. (1952) wrote in his review of the Abnormal Psychology and Modern Life [ Citation: Review of the book Abnormal psychology and modern life, by J. C. Coleman]. Journal of Educational Psychology, 43(8), 493–495. https://doi.org/10.1037/h0049597]

Meltzer H. wrote-

C[To write a textbook on abnormal psychology that can be useful to students who are studying psychology professionally, and also be helpful to citizens at large who live in a world of anxiety, is the aim of Abnormal Psychology and Modern Life as stated by the author, James C. Coleman. It is quite obvious throughout the book that the author has made a strenuous effort to satisfy this aim by taking every opportunity to popularize for use, modernize for display. The book is designed to be–and to a fair extent is–new, different, stimulating, seemingly comprehensive, practical and popular. Every attempt has been made by the author to make this ‘the’ abnormal psychology book of our time. Fifteen chapters of material are presented under four parts. Part One is composed of the background for the modern view of abnormal behavior; Part Two, called “Dynamics of Normal and Abnormal Behavior,” is composed of a consideration of personality development and causes of abnormal behavior. Part Three, called “Abnormal Reaction Patterns,” is composed of seven chapters dealing with a variety of behavior pathology, including psychotic and psychoneurotic disorders, as well as disorders with brain pathology and mental deficiency. Part Four is composed of four chapters on “Diagnosis,” “Therapy,” “Prevention of Abnormal Behavior,” “Psychiatry in the Modern World.” This book can serve adequately for a course in abnormal psychology and can be read to advantage by intelligent lay readers].

A Lot in a Name- “Madness and Civilization”

I have named the first series of my mad expedition, ” Madness and Civilization” rather more appropriately it should be rechristened as “Madness and Civilizations”. At the outset I clarify that my nomenclature has nothing to do with the most comprehensive book by almost the same name “Madness and Civilization” written by Michel Foucault whose first English translation got published in 1964. I have read the book and have conceptual, intellectual and existential differences with its tone, contents and conclusions. Also Foucault’s scholarship is myopic. To him it was only the Western conceptualization of the Madness that mattered . Also, his book has temporal limitations. He did not decipher madness prior to fifteenth century even cursorily.

Also, the original name of the book of Foucault in French was “Histoire de la folie à l’âge classique,” whose English translation should be “Madness and Unreason: the History of Madness in the Age of Reason”. The famous historian of Madness, Andrew Scull [citation:CMAJ, July 12, 2016, 188(10], in his paper “Madness in Historical Perspective” writes that while Richard Howard the English translator of the book wanted to give its orginal title “Madness and Unreason: the History of Madness in the Age of Reason”, to the book it was the publisher of the first English translation who surreptitiously changed the name of the book to “Madness and Civilization” and published a much abridged version. The publisher baulked presumably because he feared a 700-plus-page tome by a then little-known French academic would find no reader.

I have also had the opportunity to internalize the book .”Madness in Society:Chapters in the Historical Sociology of Mental Illness” written by George Rosen (the University of Chicago Press, 1978). Rosen a well known medical historian of his era, undertook an expedition in the book a rather difficult task by embarking on to decipher the societal attitude towards the mad through the ages  including the Biblical period, ancient Greece and Rome, and the Middle Ages up to the present early 1980s. I found the book interesting, scholarly and informative and worth the time I spent on it. It gave me some intersting perspective and grounding on the history of madness and the societal response to its different manifestations..

Its one specific chapter on the psychic epidemic in Europe gave me interesting insight about treatment of madness across centuries in Europe but i had to look else where for what madness meant in the ancient and medieval India, China, Islam and other parts of Asia and Africa. Also, I found too much focus on the social stress as the causative factor of madness rather enervating and unacceptable to my inquisitive mind.

However, the historian of the madness, whose extensive work that motivated me partially to write my own treatise on the Madness and Civilization is Andrew Scull, the Distinguished Professor of Sociology and Science Studes at University of California, who previously taught at the University of Pennsylvania and Princeton.

No one has spent more time than Scull over past 50 years in decoding every aspects of madness in all its nuances comprehensively. And no one has compelled me more than his writings to begin writing my own treatise of Madness and Civilization and I must acknowledge my debt to all his works on the scholarship on madness including the latest “Psychiatry and its Discontent (2019) and “Desperate Remedies-Psychiatry’s Turbulent Quest to Cure Mental Illness (2022), and the most comprehensive treatise on ” Madness and Civilization” titled “Madness in Civilization-A Cultural History of Insanity -From the Bible to Freud, from the Madhouse to Modern Medicine.” (2015).

I will return to the body fabric of the life time work of Andrew Scull again and again.

As I proceed on this enterprise, it suffices to say here, that the readers will notice that at times my thought process will coincide with that of Andrew Scull, at times they will collide with his, at times will run parallel to his thoughts and often will my train of thought run against that of Skull. But i do agree with one fundamental fact that Scull has enunciated about madness “It’s most solitary of all the human afflictions”. I further add my own conception, madness is also one human affliction which has doggedly refused to open its secrets to science.

I have named the principal heading of the first set of pieces as “Madness and Civilization” for the simple reason that I will begin this journey grappling with the treatment of madness in all the ancient civilizations in some detail – including but not limited to-Vedic period of Bharat Varasha, old Chinese period, Biblical era starting from the Old Testament and beyond. I will also distill the madness from old Greek and Roman era as well as its treatment in the Islam. From the ancient world my journey of seeking knowledge will traverse to the medieval era across civilizations before hitting madhouses and lunatic Asylums. I call these periods, the era of madness before psychiatry or lunatic asylum where mad doctors first cut their teeth in the Victorian England and contemporary Europe and later USA before colonizers brought their type of mad houses and lunatic Asylums to colonies including India.

The Caveat

As my Expedition will often traverse along the path that will pitt me against the dominant contemporary paradigm of the madness and it’s treatment I begin with few caveats. Firstly I have read Szasz T. and his “The myth of mental illness”. (New York: Harper and Row; 1961). I have also read others of the genre of Szasz and their present era disciples and followers. and i completely disagree with their conception and what they stand for .

I debunk the myth of their myth.

For me the madness is not a myth, it is the very real thing- a very serious and solitary affliction that humans face. I am painfully aware that the progress that psychiatry has made over decades if not centuries, has provided some real genuine relief to sufferers of varied forms of madness, and many have been effectively treated if not cured altogether.

I do not negate the efficacy of psychiatry, how ever imperfect it may be and even though it does not have yet the magic bullet of psychiatric pencilin yet. I am also consciously aware that had psychiatry not come up as a branch of medical science, there would have been many more severely mad men and wome, boys and girls and transgender who would have been groping in the dark.

But in my writings as I proceed, the readers will at times find me pitted against the profession of psychiatry, its incarnation of past and underpinnings of the present. My visceral fight is not with my psychiatrist friends (and I have too many of them both in India and outside) and the benefits psychiatry has brought in its train or even the side effects of the psychiatric medicines.

My fight is philosophical and existential and all together at rather very different level and primarily it is two fold- firstly, against the total biological reductionism of madness by the discipline of the psychiatry ignoring very valid psychosocial and sociocultural determinants of madness and secondly, maddeningly following the dictates of American DSM (current edition DSM -5-TR) that has ensured that madness is today the defining definition of humanness, and normal is relegated to the unconscious. For me the madness is both an affliction of brain (the body) and mind (the manas) and I have valid reasons to say what i say and will elaborate upon it as I proceed.

I may be a layman whose diatribe against the DSM, which in the popularity of number of copies sold competes with the likes of Bible, Quran, Ramayana and Bhagwad Gita, may be naive or even misplaced. But there are others more scholarly who are more scathing in their denunciation.

That takes me to what reputed American scientist Thomas Insel, then Director of National Institute of Mental Health (USA) said in 2013′ He said-

(Quote) “Thirty years after the biological psychiatrists declared victory, all of psychiatry’s diagnostic categories were still based, not on any biological markers of the disease, but merely ‘on a consensus about the cluster of symptoms’. In the rest of the medicine, he said scathingly, this would be ‘equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.’ (Unquote)”

[ Citation: Thomas Insel, “Transforming Diagnosis” NIMH Director’s Blog Posts, April, 29, 2013 http://www.nimh.nih.gov/about/directors/thomas-insel/blog/2023/trasforming-diagnosis.shtml ]

Insel was not a solitary mad cap, he presided over NIMH the foremost American Mental Health institute. And in his castigating remarks he had company. In the same year (2013) his colleague, Steven Hyman, who also happens to be another NIMH Director, was aghast at the abandonment of the field of psychiatry to the pharma industry. He noted-

“In spite all the 1980s declaration of revolutionary science, driving change, pshychatry had no good new ideas about molecular targets for diagnosis and treatment since the 1950s. As a cosequence, ‘the underlying science remains immature…therpeutic development in psychiatry is simply too difficult and too risky”

[ Citation: Steven E. Hyman, “Psychiatric Drug Development: Diagnosing a Crisis”, Cerebrum: Dana Forum on Brain Science (April, 2013)]

The Tail Piece

To the erudite readers, who might be wondering what two NIMH Directors Insel and Hyman were lamenting at, I leave a paragraph from a piece in the Los Angles Times, dated July, 1980 to philosophize. The member of the commentariat wrote the following while reporting from a major American Psychiatry Association (APA) conference –

” Ten years ago, the typical psychiatrist was still something of a Freudian facsimile, an aloof figure guiding his troubled patients-on the couch- through the mazes of their unconscious……

No more ….The typical “shrinK” of the 80’s is more likely to view “craziness” as a combination of genetic, developmental and environmental stress factors coming together. And the excitement in the field centers on advances in brain biochemistry and neuroanatomy; conventions and seminars on such subjects as ” the psychopharmacology of depression” now draw standing room crowds”

[ Citation as reported in Introduction of the book: Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, by Anne Harrington]

Suffices to say that what Insel and Hyman found correct in 2013, holds good after more than a decade in 2024. I further add I am yet awaiting the advances that psychiatry promised in 1980 with so much of fanfare.

Watch Out For

The scholarship of history of madness is relatively new and most of the historians of madness are non psychiatrists-largely most are eminent sociologist, few historians and an odd philosopher and anthropologist. Shrinks barring few exceptions have not in general considered this discipline worthy to waste their precious time. In the upcoming pieces of the “Madness and Civilization Series”, I will cover Madness in ancient Bharat Varsha, Madness in ancient China, Madness in the era of Bible, Greeko Roman Culture and Madness in early Islamic era

Till then Alvida.

( Note: Follow the Author on his blog site akhilvaani.blog : X-Handle – @akhileshlinky and Linkedin – Akhileshwar Sahay. He’s also available on akhileshwarsahay@gmail.com)

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