In a few weeks, I’ll be teaching one of my favorite classes. “Madness and Society: From Ancient Times to the Present” pretty much does what it says on the tin. We examine the long and controversial history of mental health and illness, starting with the Ancient Greeks and Romans, charting the rise and fall of the asylum and the emergence of modern explanations and treatments. Along the way, we discuss the relationship between mental health and different themes, including religion, gender, race, and class. Throughout the class, I try to show how history helps us to understand why we explain and treat mental illness in the way we do today, potentially empowering us to change our approach for the better.
But what about that word “madness”? Why do I use that term instead of “mental illness” or something else? Here’s where it can get complicated for a historian.
Historians don’t like using anachronistic terms to describe what happened in the past. For instance, I have written about the many terms used to describe what began to be called attention deficit hyperactivity disorder (ADHD) in the 1980s.
The first description of a disorder that sounded like ADHD emerged in 1957: hyperkinetic impulse disorder highlighted hyperactivity and impulsivity, but didn’t mention inattentiveness specifically. Children with similar symptoms were sometimes diagnosed with minimal brain damage, but since that indicated some kind of brain injury (and not all children presented that way), the term minimal brain dysfunction eventually replaced it. Another term, Strauss syndrome (named after Alfred Strauss), was also used to describe children with similar symptoms who had evidence of brain injury.
In contrast, the term hyperkinetic reaction of childhood, found in the second edition of the Diagnostic and Statistical Manual of Mental Disorders, suggested that such symptoms were some kind of a response to external factors. Psychoanalysts often described such children as “acting out.” Finally, in DSM-III in 1980, the term attention deficit disorder (with or without hyperactivity) appeared, showing that not all children diagnosed with the disorder needed to be hyperactive, but then in 1987 the revised version of DSM-III brought hyperactivity back in again.
Rather than assuming that people using these disparate terms in the past meant exactly what we mean when we use the term ADHD, isn’t it better to figure out what they really meant? When we do that, we begin to realize that the history of ADHD is a little more complicated and nuanced than we might have assumed.
So let’s return to that term “madness.” Why do I use that and not another term? Some terms used to describe mental illness are considered offensive today. “Lunacy” and the related noun “lunatic,” for instance, come from a Latin term meaning struck by the moon or moonstruck. The term has been used for nearly 2,000 years in the Latin language and back to around 1300 in English. We see the terms lunatic and lunacy being used formally in the 19th century, for instance in the names of asylums and the English Lunacy Act of 1845. But for many decades the term has been considered offensive, partly due to the connotation that the moon has something to do with mental illness and partly due to the term’s corruption into the slang term “loony,” as well as other factors.
Another term commonly used to describe mental illness in the past was “insanity.” Use of this term (and the term “insane”) goes back to the late 16th century, and we still see it being used today in legal settings when a lawyer invokes the “insanity defense.” Unlike the terms lunacy and lunatic, the term insanity doesn’t have a noun equivalent, which may make it slightly less offensive. Nevertheless, it isn’t used anymore in medical settings, so I’ve never considered calling my class “Insanity and Society.”
What about mental illness? While I have been tempted to call my class “Mental Illness and Society,” there are a couple of problems with this term. First, the terms “mental health” and “mental illness” don’t go back all that far back. Both can be dated to approximately the 18th century and didn’t become dominant until the 20th century. Second, there is the focus on illness. Calling mental illness mental illness asserts that the characteristics or behaviors exhibited by an individual are automatically a sign of some underlying pathology, disease, or disorder. And some people diagnosed with mental illness contest this, arguing that they are not ill at all.
And this brings me to the term “madness.” Madness has been used to describe wild, deluded, or imprudent behavior since the late 14th century. Like lunacy and insanity, it was used to describe facilities that housed the mentally ill, specifically madhouses. But it’s a little more generic and vague. Mad can mean “crazy,” but it can also mean angry. One of the reasons I chose to use it for the title of my class, however, is that it is the term reclaimed by “mad” people to describe themselves. To them, “mad” doesn’t necessarily mean mentally ill, not least because “madness” isn’t a medical term applied by doctors, but a reclaimed term that people are able to apply to themselves, a term people can take a certain pride in. Since the early 1970s, the reclamation of the term has led to the Mad People’s Movement, Mad Pride, and, more recently, Mad Studies.
So, there are some historical reasons for why I use the term madness as opposed to other terms. But probably the most important reason is that if madness is a term chosen by the mad, it’s also good enough for me.