Saturday, April 25, 2015

Madness in civilisation

I'm not sure if it really works, as I did in my previous post, collecting together tweets of quotes or amended quotes from a book which I've sent when I'm reading it. Another book I've recently read is Andrew Scull's Madness in civilization: A cultural history of insanity from the Bible to Freud, from the madhouse to modern medicine. It has been reviewed by Phil Thomas on Madness in America. I don't think the book is as good as some of Scull's previous books, such as Madhouse (see my BMJ review). It's trying to provide a wide-ranging survey of the history of madness over the last 3000 years. 

What I tweeted about from Scull's new book was the way that we seem to need myths to understand madness and illness in general. For example, the theory of the four humours - blood, phlegm, black bile and yellow bile - remained a major influence in understanding the working of the body until well into the 1800s. But we haven't really advanced:-
Biomedical hypothesis justifies modern psychiatric practice in same way as humoral theory justified bleeding, purging and use of emetics
29/03/2015 10:56
Humoral theory of disease was immensely powerful, making sense of symptoms and pointing the way towards remedies for what had gone wrong.
28/03/2015 20:22
Humoral theory provided reassurance to the patient and an elaborate rationale for the interventions of the physician
28/03/2015 20:24
This wasn't the only theory:-
Religious and secular, supernatural and what purported to be naturalistic explanations of illness persisted down the centuries
28/03/2015 20:27
Notion that madness might sometimes be a means to truth (divine madness, as some would have it) would resurface repeatedly
28/03/2015 20:27
Anti-phlogistic physicians saw disease as fundamentally a problem of inflammation and fever.
28/03/2015 20:29
Bleeding, purging and making use of emetics, all designed to counteract and to deplete the over-active, over-heated body
28/03/2015 20:30
Religious and spiritual interventions might be tried alongside the bleeding, purging and emetics of the anti-phlogistic physicians
28/03/2015 20:31
So, the notion of chemical imbalance in the brain (eg. see previous post) even though it's wrong, like humoral theory, persists because it provides an 'aura of factuality' (see previous post). The historical perspective provided by books like Madness in civilisation helps us to realise that modern claims about brain dysfunction in mental illness are not really facts but part of a myth, even delusion, to suggest an understanding of mental illness and justification for its treatment.

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