and a system of rewards and pimi,hments (Whitaker 2002). .... General Hershey, director of the Selective Service System from 1941-70, presented data on the.
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13 Madness A critical history of 'mental health care' in the United States Tomi Gomory and Daniel j. Dunleavy
The late medical historian Roy Porter defined madness as the 'generic name for the whole range of people thought to be in some way, more or less, abnormal in ideas or behavio,ir' (1987: 6, emphasis added), He notes that, 'even today we possess no ... consensus upon the nature of mental illness ... Short of the discovery tomorrow of the schizophrenia gene, these controversial issues will not be quickly settled' (Porter 1987: 8-9). Despite decades of research, no genes or biomarkers have been discovered for any 'mental' disorder (Andreasen 1997, 2007; Boyle 2002), Though there ;ire numerous theories about the natnre of madness (Read et al, 2004), none have been scientifically validated. Despite these scientific uncertainties, one of these theories has persi.,ted - namely, madness as medical disease, Thi., presumption has dev.istated oi1r understanding of it. Sdence generally advances through tri.tl and error examination of testable hypotheses: those which explain previously unexplainable observations and can make novel predictions temporarily triumph (e.g. C;i.rnap 1974: 6-16), Madness as medical disc;ase fails to do thh and marginalises alternative views. What follo,vs is a succinct history of how the agc;-old pnJblem of madness became the medical problem of mental illness, The ai1alysis identifies two recurring i.~sues: one, the identification of a heterogeneons troubfu1g seg111e11t of the popufation, the mad 'who persi.~tently create havoc, discord and disarray ... creatringl extraordinary burdens for others' (Scull 1993; 353), a11d the other, the esc;i.fation over time of bure,lUcratic institutional govern1nent supported 'psychiatric' control and coercion under the cover of medicine.
The beginning The Greeks originated the discussion on madness and their ideas have been very influential. For them, madness meant the loss of reason - the noblest faculty of man; its highest expression being to 'know thyself' (Popper 1998), Reason was counterbalanced by its opposite, irmtio1wlity, which was viewed as the major threat to human survival.Western civilisation embraced the centrality of reason for human development while minimising the impact of irrationality (Porter 1987). The Greeks had two principal explanations of irratill University
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7 A critical history of 'mental health care'
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