Benjamin Reiss, Theaters of Madness: Insane Asylums and Nineteenth-Century American Culture (Chicago and London: University of Chicago Press, 2008), pp. 237. £34.50 hb. ISBN: 0-226-70963-9. £14 pb ISBN: 0-226-70964-7.
When Dickens first toured America in 1842, he decided to visit many of the country’s public charity institutions. At Boston he looked around the State Hospital for the Insane and later reported, in American Notes (1842), that the asylum was
admirably conducted on those enlightened principles of conciliation and kindness, which twenty years ago would have been worse than heretical, and which have been acted upon with so much success in our own pauper Asylum at Hanwell. ‘Evince a desire to show some confidence, and repose some trust, even in mad people,’ said the resident physician, as we walked along the galleries, his patients flocking round us unrestrained. Of those who deny or doubt the wisdom of this maxim after witnessing its effects, if there be such people still alive, I can only say that I hope I may never be summoned as a Juryman on a Commission of Lunacy whereof they are the subjects; for I should certainly find them out of their senses, on such evidence alone.
The Boston State Hospital operated on the system of ‘moral management’, a movement that dominated psychiatric practice from the late eighteenth-century onwards. As Benjamin Reiss’s excellent Theaters of Madness illustrates, the system originated in late eighteenth-century France and was based on the non-restraint methods of radical physician Philippe Pinel. The treatment’s fundamental principle was that patients did better when they were controlled by persuasion and trust, rather than by chains and cold douches. The Hanwell Asylum in Britain, presided over by Dickens’s friend John Conolly, demonstrated that, when patients were given small responsibilities (such as gardening) and/or entertainments (such as private theatricals), they could be rehabituated successfully into ‘normal’ social functioning.
The most iconic image created by the moral management treatment was that of the ‘lunatic’ being liberated from his or her manacles. Reiss makes much of Tony Robert-Fleury’s painting ‘Pinel Freeing the Insane’ (1876), featuring a determined yet benevolent Pinel ordering the removal of heavy chains from the limbs of exhausted and harmless women. Theaters of Madness demonstrates how the liberation of alleged lunatics had a powerful significance during the French Revolution. Yet this book’s main strength is its persuasive demonstration that, in the supposed land of the free, the image of the unshackled mental patient continued to relate to wider political and philosophical debates over the meanings of progress and freedom. In a fascinating chapter on the use of ‘blacking-up’ in the New York State Lunatic Asylum, for instance, Reiss claims that madness and blackness had much in common:
Blackness and madness were two social categories that justified both the social marginalization and custodial care of supposedly subrational populations. Blacks and the insane were denied property rights because they lacked the capacity to manage that most important of properties: themselves. (p. 53)
By studying accounts of the asylum’s minstrelsy shows in the institution’s in-house journal The Opal, Reiss is able to trace a ‘fascinating twinning of self and other, noise and refinement, rationality and madness’ and to demonstrate just how central the concept of moral management had become to some of America’s biggest issues.
The image of the insane asylum had thus a forceful hold over the nineteenth-century imagination. Thanks to the work of Elaine Showalter, Sally Shuttleworth, Jenny Bourne Taylor and, most influentially, Michel Foucault, we have a stimulating range of theories for why this was the case in Europe. The lunatic asylum’s intricately-managed power structures became a fitting symbol of the wider struggle for control in a period of immense development and political unrest. Nineteenth-century American psychiatry, however, has been a neglected part of this subject area until the appearance of the book currently under review. The monograph is, in Reiss’s own words, ‘a series of snapshots of cultural life in the nineteenth-century asylum and asylum life in nineteenth-century culture’. Divided into two groups of chapters that explore ‘the cultural activity of inmates and doctors’, then ‘what these institutions […] looked like to critical observers from the outside’, Theaters of Madness does ‘not pretend […] to achieve thoroughness or even representativeness’ but concerns itself with the ‘exceptional, strange, or offbeat’ (p.17).
Notwithstanding, the author does explore some familiar territory. Chapter five, entitled ‘What’s the Point of a Revolution? Edgar Allan Poe and the Origins of the Asylum’, deals with the links between conceptualisations of insanity and political insurrection, while chapter six, ‘Out of the Attic: Gender, Captivity, and Asylum Exposés’, offers another look at the incarceration of female patients as emblem of the marginalisation of women in general. But it would be unfair to suggest that this is territory that Reiss should have avoided. On the contrary, his study is able to advance our knowledge of these issues because it never loses sight of the fact that asylum culture was made up of complex and contradictory realities for all of those involved. Take, for instance, his use of the tremendously-familiar Foucault. Theaters of Madness is clearly inspired by Madness and Civilization (1965): its argument never wanders far from the Foucauldian belief that the mechanics of power within the asylum crystallised wider methods of social policing. Yet Reiss rightly takes issue with Foucault’s sweeping simplifications of psychiatric medicine and therapeutic practice: ‘A sense of the struggle that ensued at every point in the management of institutions is something that – as numerous critics have pointed out – Foucault’s Madness and Civilization does not address’ (p.10). And this, indeed, is another reason why Theaters of Madness is a great book: it highlights how the psychiatric institution became a powerful cultural icon not because every inmate and every doctor behaved uniformly (as part of a large panoptic machine) but because the asylum experience differed enormously for most of those concerned. The findings of Foucault, important though Reiss finds them, do not do justice to the complex variations of experience that comprised the American treatment of psychological disorder – ‘variations’ that allowed for a range of conflicts and persuasions to be staged, voiced, and managed.
Theaters of Madness is, then, a welcome and persuasive study. Energetically written and selecting for analysis the areas that warrant, for varying reasons, the rigorous attention of its author, this monograph provides a stimulating account of the intersections between insane asylums and nineteenth-century American culture. Despite the author’s suggestion that he can stake no claim to ‘thoroughness’ or ‘representativeness’, his book is actually a solid and authoritative handling of its subject.
Andrew Mangham, University of Reading