#85: What Is Madness? Psychiatry, Power & the Human Mind — Andrew Scull

What is madness?

Is mental illness something medicine discovers—or something societies define? Who gets to decide what counts as abnormal? And what happens when institutions acquire the authority to define, diagnose and treat the human mind?

In this episode of The Prometheans, I speak with Andrew Scull, one of the leading historians of psychiatry, about the long and troubled history of humanity's attempts to understand madness.

From religious interpretations of possession and divine madness to the asylum, psychoanalysis, lobotomy, electroconvulsive therapy, psychopharmacology and modern neuroscience, Scull examines a recurring pattern in the history of psychiatry: extraordinary confidence in new theories and treatments, followed by the discovery of their limitations—and sometimes their devastating consequences.

We discuss his monumental book Madness in Civilization, which traces changing understandings of madness from antiquity to modern medicine, and Desperate Remedies, his history of psychiatry's turbulent attempts to cure mental illness.

We also confront one of the great intellectual debates in the history of psychiatry: Michel Foucault's interpretation of madness, confinement and power. What did Foucault get right? Where does the historical evidence challenge his account? And can we take the relationship between psychiatric authority and social power seriously without accepting Foucault's historical conclusions?

The conversation also explores:

• What exactly do we mean by "madness"?

• Is madness a universal human phenomenon or a category constructed by societies?

• Religion, possession, melancholy and "divine madness"

• Why did psychiatric institutions acquire so much authority?

• Henry Cotton and the terrifying confidence of "focal sepsis"

• Lobotomy and the history of psychiatric treatment

• The rise and fall of psychoanalysis

• The transformation of psychiatry through psychopharmacology

• Deinstitutionalization and the promises of community care

• The DSM and the problem of psychiatric diagnosis

• The biological turn in psychiatry

• What the history of psychiatry tells us about scientific progress

• Whether psychiatry has learned from its past

• And what a genuinely humble psychiatry might look like

Scull's critique is neither a simple rejection of psychiatry nor a romanticization of madness. His work asks a more difficult question: how can a profession devoted to alleviating profound human suffering exercise enormous power while remaining honest about the limits of what it knows?

Andrew Scull is Emeritus Distinguished Professor of Sociology at the University of California, San Diego.

Books discussed:

Madness in Civilization

Desperate Remedies

Psychiatry and Its Discontents

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