Masters of Bedlam. The Transformation of the Mad-Doctoring Trade
Andrew Scull, Charlotte MacKenzie, Nicholas Hervey
Princeton, New Jersey, Princeton University Press, 1996, ISBN: 9780691034119; 408pp.
Oxford Brookes University
Date accessed: 1 June, 2023
Given the efflorescence in the history of psychiatry over the course of the last quarter century, it is surprising that so few of the new generation of psychiatric historians have ventured into biography. However, largely as a consequence of an historiographical heritage where biographical studies of past figures in medicine were mostly stories of the great and the good and their achievements – the profession's own self-generating hagiography – historical biographies have generally fallen into disrepute. This is a shame, for it is the frequently rather celebratory, self-congratulatory and antiquarian approaches made to biography that have been wanting, rather than something germane to the discipline of historical biography itself. And given that we still lack high quality biographical studies of many of the major players who have shaped psychiatry's past and present, one can only welcome the arrival of Masters of Bedlam. For, in the main, it represents a highly successful attempt to locate the lives and works of some of the most prominent members of Victorian psychiatry's elite in Britain against a broad cultural, contextual and structural background.
The book is divided into nine chapters, the core seven (framed against a brief general introduction and conclusion) dealing with seven specialists in insanity, four English and three Scottish. These subjects are, namely: John Haslam, notorious for his public office as the Apothecary of Bethlem Hospital, but relatively esteemed for his authorship on insanity; John Conolly, onetime Superintendent of Hanwell Asylum in Middlesex, and long distinguished as the pioneer of non-restraint in the treatment of the insane; W. A. F. Browne, Superintendent of Montrose Royal Asylum and latterly Crichton Royal Institution in Dumfries, Commissioner in Lunacy for Scotland and asylum reformer par excellence; Sir Alexander Morison, Visiting Physician to Bethlem, most notable however for his early development of a private consultancy practice outside the asylum walls; Samuel Gaskell, Superintendent of Lancaster County Asylum and latterly an English Lunacy Commissioner; Sir John Charles Bucknill, onetime Superintendent of Devon County Asylum, and a major proponent of non-institutional care of the insane in private dwellings; and finally, Henry Maudsley, founder of the Maudsley Hospital, the archetypal insider-outsider, controversial editor of the profession's primary mouthpiece, the Journal of Mental Science, and an unrepentant critic of traditional asylumdom. If there is a problem in the representativeness of the figures selected, being members of the elite rather than the more numerous 'rank and file' (especially given what M. Jeanne Petersen has stressed was a radical divide between medical professionals at the top of the pile, and those underneath), the authors remain acutely appreciative of this fact (e.g. pp. 8, 61). Indeed, they give full coverage both to those areas where their subjects are reflective and revealing about the norms of contemporary psychiatry, as well as to where they are innovative, unusual or eccentric. Moreover, with careers located on either sides of significant divides, working in both the private and public asylum sector, both within and outside the asylum walls, pursuing endeavours in medical theory, clinical practice, and in legal and forensic medicine, and with profiles and postures adopted both for and against central administration in lunacy, these individuals provide the authors with a welter of opportunity for commentary on a whole range of developments in psychiatry and lunacy administration during this period.
Considering his own background and sympathies as a sociologist tending to emphasise and be interested in broad structural paradigms and discontinuities, above and beyond the influence of individuals on social structures, causality and change, Scull is perhaps an odd advocate of the virtues of biography. And what we have here seems as much an attempt to go beyond biography, as it does to persuade of its merits. On the one hand, the apparent concern to transcend biography, and knit individuals to their contexts, their histories to existing historiography, works beautifully to place mad-doctors' careers in the setting of macro and exogenous shifts – including the 'rise of professional society'; the increasing role of the central state in lunacy provision; and the growth of a capitalist marketplace for medical and all kinds of other services. On the other hand, this sometimes leads to overlong and rather uncomfortable digressions in which the key subject is lost, submerged or only marginally concerned. Thus, for example, while the rise and professionalisation of psychiatry; the history of the professions in general; and the lunacy reform movement; are obvious themes in which to locate the mad-doctors with which this book is concerned, we are intermittently treated to extensive asides on these and a host of connected subjects (e.g. pp. 22, 91–8).
There is the usual preoccupation one has come to expect in Scull's writing with the ironies by which mad-doctors rose to prominence, with the contradictions and numerous 'volte-faces' that punctuated their careers. On the whole, these are well observed and lead to some pointed analyses of the self-interest, prejudices and professional imperialism that often underlay the strategies, opinions and actions of medical men with aspirations for pre-eminence. Conolly, for example, emerges as a most unlikely psychiatric patron-saint, beginning as a 'stern critic of asylum treatment' and of the private trade in lunacy (e.g. pp. 53–5, 65), only to end up, in ways that (too intimately for comfort) reflected the changed pattern of his career path, as a devoted champion of asylumdom and a defender of private institutions (e.g. pp. 79, 82). Conolly is convincingly portrayed as, for much of his career, the wrong man in the wrong place, whose claims to distinction rested as much on a distortion of the historical record of non-restraint in which he was complicit, as to his vision as a moral therapist or talents as an asylum administrator (pp. 70–72). Yet one cannot escape the impression that there is something rather hobbyhorse-like about some of this. Indeed, the authors' lens is perhaps too gleefully focused on exposing the ulterior motives of medical men, on cutting them down to size, rather than simply and concisely demythologising the 'pantheon of [psychiatric] heroes' (pp. 48, 158), before moving on to other, equally rich pastures. Occasionally, as a result, the tone of the account is too begrudging, and some interpretations appear narrow, exaggerated and over cynical, as when concerns with being dismissed, losing licenses and income, and safeguarding 'professional standing and privileges', are portrayed as the only motivations for pauper asylum superintendents and their private-sector colleagues' feeling 'beholden' to the new Lunacy Commission (p.7).
Taking their lead from sociological and historical studies of professionalisation, from Magali Larson and M. Jeanne Peterson to Harold Perkin, the authors generally portray mad-doctors as rather directed, self-promoting and calculating in their words and deeds, engaged in a 'project of collective [and, indeed, competitive, individual] social mobility' (e.g. p.6). One is prompted to ask whether there is not a natural enough tendency for all existing or nascent professions (academics included) to seek to further and to protect their own interests? Nor, perhaps, in so doing, should a profession be too uniformly portrayed as being either calculating, or necessarily at odds with more widely shared concerns, let alone so self-consciously determined, or able to subordinate other interests, even when they were in competition. While, often, the authors are appreciative of the limits to psychiatric power and self-interest (it is fully conceded, for example, that Conolly was a poor strategist when it came to constructing a medical career, although compromised by his social origins, and that Maudsley's stance on asylumdom was, at the very least, a rather maverick, damaging course to chart), sometimes they seem to want to have it both ways. Overall they appear to neglect, or simply not to credit or be interested in, the place of altruistic, or less selfish motivations for the common good (as mad-doctors saw it), as well as the influence of chance, experience, opportunism, and adjustment to circumstances and wider forces of change, as important or motivating factors (e.g. p. 82). Bearing in mind the ongoing debate Scull has had with Gerald Grob (amongst others) as to judging historical actors by their declared intentions (Scull typically and wisely stressing the gap between intention and outcome, and importance of unconscious motivations), the preoccupation with underlying intent and dubious results should not surprise us. But the analysis does intermittently seem to fall into the trap of always seeking to unearth the darker, more egotistic sides of human conduct.. Ultimately, of course, and this once again emphasises the distance at which some more traditional biographical approaches are put, this survey is not about good or bad intentions. Far from it, it is concerned with the consequences of individual's words and deeds; their impact on and foundations in social structures; their signification as indices of shifting professional, moral and cultural ideologies; and their pertinence to the forces and structures dominating professional formation, status and aspirations.
Overall, however, the authors portray both the ambitions and the disappointments of their subjects with remarkable fairness, objectivity and insight, assessing their personal biases and rivalries, and the ambiguities of their achievements to great effect. More often than not, credit is given where credit seems due, as when John Haslam is acknowledged to have been, at least in part, inequitably scapegoated by the 1815-16 Madhouses Committee (pp. 18, 33); and is recognised for integrating (at least in theory) the new ethos of moral therapy into older doctrines of the management of the insane (pp. 27–8), as well as for becoming an internationally acknowledged authority on insanity (pp. 22–3). At the same time, obvious and less than obvious failings are unflinchingly exposed, as with Haslam's intransigence, conservatism and arrogance in the face of the lunacy reformers and all other opponents (pp. 37, 44–7), and his derogatory, dismissive and imprudent treatment of his patients, James Tilly Matthews especially (pp. 34–5). While other criticisms in such areas might arise, Scull and his co-authors are normally sufficiently subtle and perspicacious to anticipate and out-flank such (as on p.28, where distancing themselves from historiographical tendencies 'to assume a correspondence between someone's published work and their clinical practice'). Indeed, it is a sign of the significant accomplishment these various portraits represent in that they remain so persuasive and appreciative of the complexities of personal motivations, actions and career paths, while sustaining such a regular responsiveness to their various meanings as against the broader transitions in contemporary culture and social structures.
There is some particularly impressive and well-researched analysis of the links mad-doctors forged with other interest groups, both lay and medical, central and local, as well as of the social and intellectual origins of each individual subject and the ways in which, whether by hook or crook, they established themselves as members of the medical elite. The authors show themselves very sensitive to the social and economic disadvantages and stigmas of 'trade' with which mad-doctoring was long associated (e.g. pp. 6, 11–14, 49–51), and highly appreciative of the various routes and means taken by such doctors to carve out their own niches and clienteles, to shore up their income and status, and consolidate their speciality. There are also some revealing insights into the ideological, practical, social and economic consequences of the religious backgrounds of these doctors (e.g. pp. 128, 164–5), as well as of their respective allegiances in political and patronage terms (e.g. p. 154). This account presents no simple, or linear picture of progression to repute and success, paying meticulous attention to the many reversals and ambiguities that punctuated its subjects' careers, and covering both the acquisition and the loss, both the regaining and the costs, of social and professional cachet.
One might question the amount of rehashed material in this book; the chapter on Browne being a virtual identikit of Scull's introduction to The Asylum as Utopia (1991), and the chapter on Conolly lifted almost entirely from previous articles by Scull already published elsewhere. In essence, in fact, this book is – somewhat inevitably, given its structure – more like a series of articles and conference papers gathered together, than it is a seamless monographic whole. While Scull's is the dominant guiding hand, MacKenzie did much of the original work on Bucknill and much of the material on Morison and Gaskell belongs to Hervey. Given what is said about professional advancement in this book, an irony may appear in the fact that it is made so transparently clear in the acknowledgements and on the front cover to whom most of the credit should accrue, yet academics too must be careful to secure their due recognition. Nevertheless, it is at the very least a testimony to the authors' stylistic sensitivity and a good degree of sympathy and happy compromise on conceptual issues that the book's seam shows as little as it does. A more salient criticism, might be that the book, despite its generally admirable exploitation of a bewildering array of sources, is sometimes too exclusively focused on alienists and their writings, and on printed sources, to the exclusion of the views of other players, patients and local authorities in particular, and also to the neglect of case materials. The major exceptions are a short interlude on Morison's attendance on private patients in single lodgings, utilising extracts from his diaries (pp. 146–8), and an even briefer but equally fascinating section on Bucknill's advice to patients as a Lord Chancellor's Visitor (pp. 218–9). The view of the interests of parochial authorities, and their attitudes to and links with the doctors under consideration, as well as with other medical specialists and with central government, is especially cursory and specialist-centred.
One doubts whether the authors' portrait of Gaskell really manages to persuade that he represents the kind of major influence they claim he was in transforming mad-doctoring during this period, and it seems impossible to dismiss as lightly as one is asked to his decided lack of publications and of therapeutic and administrative originality (p. 161). Indeed, this would seem to account for the disproportionate way in which his career is summed up by the authors in just 26 pages, by far the shortest profile in the book and one that sets a query against his inclusion. Nevertheless, the only seriously unsatisfactory chapter is that on Browne. The latter is, I would argue, severely unbalanced, mostly being devoted to an analysis of his What Asylums Were, Are and Ought To Be. Relying on this text and Browne's annual reports as Superintendent of Crichton Royal Institution, little use is made of Browne's many other published writings, nor of the clinical records of the asylum he superintended. Browne's thirteen year service as a Lunacy Commissioner is skipped over in a paragraph or so, while the authors barely refer to his rather controversial opposition to the cottage system and boarding out of the insane in private dwellings. (Indeed, they seem unaware of the notorious article, 'Gheel in the North', Browne allegedly penned anonymously in 1866, which raised a storm in the medical press, and continued to be regularly referred to by critics of boarding out for many years.)
One can only endorse many of their conclusions as to how the mad-doctoring trade had indeed 'transformed itself' by the turn of the century (p. 273). One must also concur that while critics of asylumdom like Maudsley and Bucknill were allying themselves with an 'upper-class clientele and the medical elite', antithetically they were 'diminishing the public standing of the profession as a whole' (p. 272). Yet, the conclusions also smack a little of jaundice, betraying Scull's recent preoccupation with the history of somatic treatments and incongruously moving off into a wholly new digression on the subject of Freud and psychoanalysis, the relevance of which seems rather strained, and serves merely to reiterate Michael Clark's argument made some time ago about the inveterate hostility of nineteenth-century psychiatry in Britain to psychological approaches (pp. 272–3). The judgement that 'the men who aspired to form the profession's elite sought … to leave the institutional sector behind' and 'were led to adopt intellectual positions … at odds with the interests and outlooks of the rank and file' (p. 274), seems debatable and hyperbolic. Maudsley and Bucknill appear rather unusual, when one compares the careers of men like Clouston, Yellowlees, Blandford, Conolly Norman, Mercer, Orange, Urquhart, Batty Tuke, Hack Tuke and even Savage, who retained loyal links to the asylum sector and the MPA. Institutional careers, as Masters of Bedlam itself confirms, often functioned as hotlines to lucrative private clienteles, while there were obvious incentives for aging superintendents to make way for younger men, and to prefer the flexibility, variety and extra social cachet offered by consultancy practice to the grind and routine of asylum work.
There is a degree of unfortunate overlap and repetition between chapters, partly an ineluctable product of the schema adopted and the regular return to contextual information that is common ground for most of the subjects (e.g. pp. 84–88; 118–19 & 183; 68–9 & 192–). There are also a few scanning problems; as when concepts, like ‘Christian phrenology’ (p. 242), or individuals, like 'Dr. Sutherland' (p. 134) and Dr. Charlesworth (p. 71), are introduced without adequate or previous explication; or when Haslam is said to be 'housed within the Hospital' of Bethlem, but later to be 'living at a considerable distance' (pp. 15, 19). And there are occasional typographical or factual errors, as when we have 'Mr Doury' for William Drury (p. 134) and 'humoural' for humoral (pp. 90–91). But, when one appreciates the scope of material and range of historical actors covered, it is remarkable that such problems are so scant. At the risk of, like Maudsley, being declared 'humourless', one could question the appeal of some rather flat and inelegant jokes (pp. 41, 265), and (at the risk of self-implication) the propensity towards mammoth-sized sentences, with excessive, Germanic sub-clauses (e.g. pp. 10, 90–91). One might also query the inordinate number and length of the footnotes, which make up 75 pages (over one fifth) of the book. Indeed, the footnotes are more like commentaries on the text, and however informative, often appear self-indulgent, particularly when one reflects on the regrettable lack of a bibliography.
These comments and criticisms aside, nonetheless, Masters of Bedlam constitutes an expansive and distinguished attempt to wed the biographies of some of the most notable figures in nineteenth century British psychiatry to the wider transformation of the mad-doctoring trade during the period. It is one that should in many ways serve as a model for historians embarking on biographical studies of professional men, and more generally for anyone concerned with the ways in which individuals both impacted on and reflected wider historical patterns and changes.
I very much appreciate the opportunity to respond, on behalf of myself and my co-authors, to Jonathan Andrews' intelligent and searching review of our new book, Masters of Bedlam. Dr Andrews is an unusually well-informed critic, and we are naturally delighted that his overall assessment of the book is so positive and laudatory. We hoped, in writing the book, to inspire other historians of science and medicine to reconsider the many virtues of a biographical approach, and thus are especially pleased with his conclusion that we have produced an "expansive and distinguished" and, "in the main...highly successful" volume that "should in many ways serve as a model for historians embarking on biographical studies of professional men, and more generally for anyone concerned with the ways in which individuals both impacted on and reflected wider historical patterns and changes."
At the risk of seeming churlish in the face of what is essentially a highly complimentary review, I would like to take issue, however, with some of the points Dr Andrews makes in the body of his discussion. Some of these are issues where reasonable differences of opinion exist, and where I would like to elaborate on the reasons for the stance we have taken and the choices we have made. Some are places where I think Dr Andrews has misrepresented or misconstrued our argument. And finally, a handful are minor instances where we believe that he himself has gone astray.
Let me begin with the particular choices we made about whom to discuss and dissect. We were acutely conscious of the fact that all the figures we discuss were members of the elite of the profession. This brought with it significant advantages, but also some drawbacks of a rather obvious sort: problems of representativeness; the sometimes radical differences of experiences, outlook, and options of the rank and file when contrasted with the top of the pile; and so forth. Our sense was that the benefits that flowed from a focus on the elite were far greater than the limitations this choice imposed; and that we could, with care, tease out the ways in which the individuals we wrote about reflected and revealed central aspects of the development of the profession as a whole, as well as the ways in which they were idiosyncratic and unrepresentative. Dr. Andrews' comments indicate that our decision on this front has been vindicated.
Andrews does raise objections, however, about some of the particular portraits we chose to draw. There were, of course, many more alienists whom we could have written about than we possibly had space for, even if we confined our attention to the professional elite. Men like Forbes Winslow and his son Lionel (once suspected of being Jack the Ripper), Thomas Clouston, Sir George Savage (Virgina Woolf's alienist), Daniel Hack Tuke, or Sir James Crichton Browne (W. A. F. Browne's son), will undoubtedly have their partisans, and in an ideal world, we would have included them too. (Indeed, I am seriously considering producing a second volume devoted to these and other figures for whom we did not have space on this occasion.) But we continue to believe that the choices we did make were both sensible and appropriate, allowing us to range widely across the entire century and to encompass a range of fascinating figures whose lives and careers together and separately provide a remarkable and engrossing entrée into the world of the mad-doctor. Haslam and Maudsley are clearly the leading figures at either end of the century, clever, controversial, and colourful, and by any measure central actors on this particular stage. Bucknill, as founding editor of the profession's official journal, co-author of the leading textbook in the field, and major spokesman for the profession, surely could not be ignored. And Sir Alexander Morison not only gave some semblance of academic respectability to the proto-profession through his annual series of lectures on insanity in London and Edinburgh, but also allowed us to explore the shadowy world of the non-asylum treatment of the insane - reminding us that even at the apogée of asylumdom an older tradition of treatment persisted, one with much greater ties to general medicine.
It is our other choices that draw Dr Andrews' fire, however: Conolly and Browne because (as we acknowledge in the book) substantial portions of the chapters in question have previously appeared in print; and Samuel Gaskell because of doubts about his standing and significance. Let me address each of these criticisms in turn. To omit John Conolly from our cast of characters, given his centrality to the transformation of the profession and to its public standing in Victorian Britain, would have been like trying to stage Hamlet without the Prince. W. A. F. Browne is only marginally less important, whether one's focus is the achievement and limitations of lunacy reform, or the evolution of Scottish responses to insanity. Both men certainly belong in the book. Besides, though large portions of the Browne chapter had appeared in print before, as the introduction to a reprint edition of his monograph, the absurd and extortionate pricing policies of its publisher ensured that the book sold fewer than a hundred copies before being remaindered. Save for a small handful of specialists, therefore, few will have encountered this chapter's prior incarnation. Both chapters, moreover, contain some significant new material: on Browne's machinations, for example, to secure the post of Lunacy Commissioner for Scotland, and his fraught relations with the American lunacy reformer, Dorothea Dix (discussions deriving from a serendipitous discovery of manuscript materials at Harvard's Houghton Library), and on his overt materialism and radicalism as an Edinburgh University student, and the lessons he drew from the reactions this provoked; a much fuller account of Conolly's failed venture as a Professor of Medicine at University College London, placed in the context of the medical politics of the age, and noting his bitter relations with Thomas Wakley, later one of his major supporters in the crusade for non-restraint; as well as further details about Conolly's years of provincial exile and his failed efforts in behalf of his feckless and burdensome son.
As for Samuel Gaskell and his importance, Andrews and I simply disagree, and readers will have to judge for themselves which of us is correct. The derivative character of Gaskell's ideas about insanity is beyond question, but absence of intellectual originality may tell us little about the larger significance of someone's career. Gaskell was an unusually dedicated and effective asylum administrator, dealing heroically with appalling difficult challenges during his time as superintendent of the Lancaster County Asylum. He has much to teach us about the spread of the Conollyite orthodoxy through the expanding empire of asylumdom. At least equally important, however, is his crucial role in transforming the character of the central inspectorate, the Commissioners in Lunacy - establishing and defining the context within which his professional brethren operated; enforcing the legal constraints to which they were subjected; and accentuating the existing pressures to make alienism an essentially administrative specialty and asylums themselves a dull, protective environment, where merely keeping the patients alive became an end in itself. In all these respects, in my judgment, examining Samuel Gaskell's life and career provide us with unique insights into the development of psychiatry in the mid-Victorian age.
I turn now to some places where I think our argument has been misrepresented or misconstrued. In the first place, the chapter on Browne quite properly gives major attention to the origins and impact of his book, What Asylums Were, Are, and Ought to Be, the most important source of his reputation and influence. It is by no means the case, however, that the chapter is "mostly devoted to an analysis [of this text]." Discussion of the book occupies about a dozen of the chapter's thirty-nine pages. Almost as much space is devoted to a careful analysis of Browne's subsequent administration of the Crichton Royal Asylum. A variety of other topics, including his early education and career and his complicated relations with the Combes and with phrenology, are also addressed at some length. Nor do we ignore Browne's various other writings, apart from his book and his annual reports: his various pieces in the Phrenological Journal, the Journal of Mental Science, and the Medical Critic and Psychological Journal; his attacks in print and in private correspondence on proposals to reform Scottish lunacy law along the lines already established in England and Wales; his presidential address to the Medico-Psychological Association; and other attempts to defend his profession's prerogatives, are all drawn upon and discussed in more than passing fashion. On the other hand, we accept that more extended discussion of Browne's activities as a Lunacy Commissioner, as Andrews suggests, would perhaps have been warranted and would certainly be useful. If we elected not to venture down this pathway, the decision reflected a judgement that Browne neither enjoyed nor made much of the job; and our desire to defer analysis of what serving as part of the state inspectorate entailed to the chapter on Gaskell. Gaskell's service as a Lunacy Commissioner was of far greater import than Browne's, and the surviving sources on the former's performance in the role are by far the richer and more interesting of the two. In our view, moreover, Dr Andrews' own forthcoming paper on the Scottish lunacy commissioners provides ample support for these conclusions: not only is he able to add remarkably little to our portrait of Browne's years as a commissioner, but his forced reliance on a very restricted range of source material (the commissioners' published reports and the minutes of their meetings) vividly demonstrates the very real limitations imposed by the nature of the surviving documents.
More broadly, and contrary to what Dr Andrews implies in his review, we share his sense that the tendency of existing or nascent professions to seek to further and protect their own interests is entirely natural and in no sense necessarily disreputable (though I would add that careerism can be singularly unattractive in many contexts, and professional self-interest may, under certain circumstances, lead one to adopt positions at odds with the interests of one's nominal clients). Andrews accepts that we emphasize the limits to psychiatric power and self-interest, and acknowledges that overall, we "portray both the ambitions and the disappointments of [our] subjects with remarkable fairness, objectivity and insight." We give "credit where credit is due" and remain "appreciative of the complexities of personal motives, actions and career paths," presenting "no simple or linear picture of progression to repute and success..." Paradoxically, however, in almost the same breath he taxes us with ignoring "altruistic, or less selfish motivations" and of at least "intermittently" falling "into the trap of always seeking to unearth the darker, more egotistic sides of human conduct."
I leave aside the contradiction implicit in the claim that one intermittently always does something or other. I also leave aside the quite vital fact (which, to be fair, Dr Andrews acknowledges) that ours is an approach which is not centrally about good and bad intentions, but rather one that argues that we must view the interaction of the individual and the social in a much broader, more complex fashion. Regardless, intent and motivation are transparently important matters. Do we in fact fail to acknowledge the dedication and self-sacrifice of at least some of our subjects? I think the answer is clearly no. We place great emphasis, for example, on Gaskell's herculean efforts in behalf of his pauper patients at Lancaster. We speak of the "characteristic vigour and determination" with which he attacked the appalling conditions he found on assuming his post at the asylum, and of his entire career as "the joint product of intellect and unremitting effort." His efforts to transform the very fabric of the overcrowded, prison-like facility he inherited are repeatedly praised as costing him "enormous time and labour." We note his refusal to be intimidated by the magnitude of the task, and we emphasize that he "provided a more humane and caring environment than most lunatics would have found in either the workhouse or the community..." Likewise in discussing Alexander Morison's solicitous regard for his patients, we provide considerable evidence of his dedication to their welfare, and the lengths to which he was prepared to go in accommodating their peculiarities and needs, even to the extent of "engag[ing] lodgings for patients and ensur[ing] that the physical environment in them was suitable to their circumstances." And we praise Browne as a "very talented administrator" devoted to his patients, someone who "took advantage of the considerable resources at his disposal [to enrich their lives] in a variety of imaginative ways."
To be sure, we take great pains to delineate the limitations of each man's vision, their blind-spots, and the unintended consequences of their actions. But to assert that we "always" emphasize "the darker, egotistical side" of these men's conduct is patently untrue. That said, I wait with bated breath for portraits of John Haslam and Henry Maudsley as men filled with the milk of human kindness. In these instances, our presentations are indeed rendered in darker (though not un-nuanced) hues, as befits the character of those we are writing about. The point is, our seven subjects are markedly different, in these as in other respects, and we have done our best to capture that individuality, warts and all. Nor, in my view, is it fair to say that we ignore the role of "chance, experience,... [or] adjustment to circumstances and wider forces of change." To the contrary, we emphasize the role of chance in, for example, such basic matters as Maudsley's entry into the profession in the first place, and John Conolly's even being given a second opportunity to obtain the superintendency at Hanwell. Experience, likewise, assuredly has its place in the stories we tell – we show, for instance, how it helps to account for Browne's changing estimate of the asylum's capacity to cure, and for Bucknill's growing emphasis on the feasibility and desirability of non-asylum treatment. As for "adjustment to circumstances and wider forces of change," so far from being overlooked, these are surely some of the central themes of the book, to which we return again and again. In the very first chapter, I lay out how essential it is to consider such interactions. "We take seriously," I stress,
the contention that people make their own history ... But we are equally aware that human action is always constrained by and responsive to the wider social and cultural context within which it occurs. In examining the constant interplay between structure and agency, we necessarily confront the inherently interactive and collective dimensions of each individual's life. Paradoxically, therefore, the very endeavour to capture what it is particular and idiosyncratic about a given actor simultaneously requires us to attend most closely to the realm of the social (p. 4).
Earlier in his review, Andrews praises Masters of Bedlam precisely for achieving these aims: "the apparent concern to...knit individuals to their contexts ... works beautifully to place mad-doctors' careers in the setting of macro and exogenous shifts - including the 'rise of professional society'; the increasing role of the central state in lunacy provision; and the growth of a capitalist marketplace for medical and all other kinds of services." How, then, can it possibly be the case that we "neglect" or simply fail to credit the role of context and circumstance in understanding our subjects' lives and the choices they made?
Turning now to some of Dr Andrews' more minor quibbles, we acknowledge that our footnotes are, indeed, quite extensive, and are vehicles for some extended commentary on points made in the text. Some, Dr Andrews included, may find these discussions "self-indulgent." Others, I suspect and hope, will find them valuable and illuminating, both in extending and adding nuance to the basic argument made in the text, and in guiding the reader to relevant source materials. I think this is a matter about which we may reasonably disagree, and of which, of course, the final arbiter will be other readers.
Less legitimate, in my view, are Dr Andrews' comments on our concluding remarks. His criticisms here, I suggest, rest on a distorted view of what actually appears in the text. First, notwithstanding my recent purported "preoccupation," the reader will search in vain for extraneous commentary on the subject of the history of somatic treatments in psychiatry. It simply isn't there. As for "incongruously moving off into a whole new digression on the subject of Freud and psychoanalysis," the reference is to a handful of sentences (amounting to less than a page) where I discuss a paradox of transparent significance: the intense resistance among the intellectual leaders of Edwardian psychiatry to a set of ideas and techniques of possible utility to those seeking to treat the still-functioning, albeit symptom-bearing patients who could form the basis for an office-based practice; and their stubborn adherence instead to somatic and degenerative accounts of madness, even though this obduracy meant that they remained impotent to elucidate the ailments they examined and all-but-incapable of intervening in any practical way in the course of these disorders. So far from being "strained," the relevance of this discussion is in my view self-evident. As for those who aspired to join the profession's elite choosing to leave behind the institutional sector as they rose to prominence, this is a pattern visible in the careers of not just Maudsley and Bucknill, but also such figures as Crichton-Browne, Savage, Blandford, and Lockhart Robertson. I continue to believe that the evidence supports our claim that such men "all too frequently were then led to adopt intellectual positions that put them at odds with the interests and outlook of the rank and file" [note that Andrews misleadingly omits the important qualification "all too frequently" when he quotes this passage]; and that "in word and deed, many of them proceeded to undermine the legitimacy of the very institutions that had given birth to medical psychology as a distinctive enterprise..." This is not a trivial point, since it helps us to understand why even in the early twentieth century, "mad-doctoring transformed...remained a handicapped and stigmatized enterprise - handicapped not just by the limitations of its own knowledge and capacities, but also by its own internal divisions..."
While rejecting these criticisms, however, I must acknowledge and apologize for the handful of typographical errors Dr Andrews points to. "Humoural" is the product of an American copy-editor unfamiliar with the vagaries of British orthography, and "Doury" for "Drury" an obvious but unfortunate slip. The complaints about scanning errors are not always well-warranted, though: Dr Charlesworth is identified (in one of the footnotes Dr Andrews regards as self-indulgent) as a visiting physician at the Lincoln Asylum; and as for Haslam being originally housed within the hospital and subsequently "living at a considerable distance," this discrepancy is carefully explained in the text, his relocation being forced by the partial collapse of the hospital's buildings. Dr Andrews must somehow have missed the relevant passage on p. 19. And though he credits us with examining the lives of three Scots and four Englishmen, the actual totals are two (Browne and Morison) and five (Haslam, Conolly, Gaskell, Bucknill, and Maudsley) respectively.
Before concluding, there is one final issue I would like to raise, because it so frequently features in reviews of my work in historical journals. I have been contributing to the history of psychiatry for more than a quarter century now. At the risk of seeming immodest, I think it is fair to claim that my work has been quite influential in historical circles, and I would like to believe that my commitment to the historian's craft had been established a long time ago. Nonetheless, virtually every time a historian reviews my scholarship, s/he seems compelled to allude to or make an issue of my background as a sociologist. Jonathan Andrews' review is no exception to this generalization.
At the risk of seeming thin-skinned, I have to confess that I find this tiresome. Nor do I think it is accidental. Sociologists do not have a good name among many historians, very often with good reason. I pride myself, however, on doing my historical homework and on accepting the discipline (forgive the pun) required to produce worthwhile historical scholarship. Hence, my annoyance at the persistent sniping of disciplinary border guards, which is all the more intense because the distinction between the two disciplines which I practice strikes me as by and large an artificial and an unfortunate one – however entrenched it has become in institutional structures over the years, and no matter how skillfully it is now rationalized by the self-interests of academic guilds. The study of human beings and human societies requires us to transcend the artificial boundaries that threaten to limit and distort our understanding, not to embrace or reinforce them. In my view, therefore, there is nothing odd or noteworthy about someone with my particular intellectual background interesting himself in or writing biography (as I have done for more than a decade and a half now). And I have good grounds for thinking that my position on these matters is not unique or idiosyncratic. After all, sitting in the next office as I write this response is my close friend and fellow member of the University of California, San Diego sociology department, Steven Shapin – someone else who trespasses regularly over the Berlin Wall dividing history and sociology; and someone else who has embraced a biographical approach in his own researches a not-insignificant fraction of the time.