The World Health Organisation (WHO) calculated in 2019 that as many as 970 million people across the globe had a mental illness.Footnote ¹ Despite its prominence today and its enduring presence throughout human history, leading scholars in the field acknowledge the immense challenges in researching the history of mental health. Borrowing lexicon from the ancient Greek myth of Sisyphus, whom the gods condemned to roll a heavy boulder to the top of a hill for all eternity, Andrew Scull described writing histories of mental illness as a ‘Sisyphean task’.Footnote ² Edward Shorter similarly labelled the history of psychiatry as ‘a minefield’.Footnote ³ The challenges of writing such histories reflect the contentious nature of mental illness itself. Despite supposed advances in medical research, the mass production of psychopharmaceutical drugs and the increase in people undergoing therapy, contemporary societies remain uncertain about how to clearly demarcate an unhealthy mind from a healthy one.Footnote ⁴ There is no uncontested and universally agreed upon definition of what constitutes mental health and mental ill health. As British-based health sociologist Peter Morrall points out, for example, the National Health Service’s utilisation of ‘mental disorder’ within the 2007 Mental Health Act provides a ‘teleological definition’.Footnote ⁵ The legislation stipulates that it ‘means any disorder or disability of the mind; and “mentally disordered” shall be construed accordingly’.Footnote ⁶ This explanation lacks clarity by vaguely referencing mental illness as a ‘disordered mentality’. By contrast, the WHO’s definition of ‘mental health’ provides a more idealistic but similarly broad and imprecise definition: ‘Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’.Footnote ⁷

The contemporary contestation of mental health cannot fail but further complicate definitions and understandings of mental illness in historical analyses. In their recent introductory essay for Healthy Minds in the Twentieth Century: In and Beyond the Asylum, historians Steven J. Taylor and Alice Brumby note:

This is a salient point. Indeed, even the acceptability and preference for terms fluctuate in different medico-legal, socio-economic and political contexts. Historians subsequently often deploy their own preferred phrases and terms that best reflect their ideological standpoint and the nature of their project and resources.Footnote ⁹ Nevertheless, this review aims to demonstrate how History, a discipline that promotes a holistic understanding of socio-political and cultural contexts, its impact on territories and institutions and the individuals residing within them, can make a unique contribution to our collective understanding of mental health.

Three broad historiographical phases define the historiography of madness, psychiatry and mental health.Footnote ¹⁰ Firstly, works were produced in the first half of the twentieth century by, and often for, medical professionals. These publications promoted a linear and ‘progressive’ history of medical advancement. They emphasised how rational and scientific psychiatry enabled a better understanding of mental illness and improved its treatment over time. Led by Michel Foucault, research adjacent to the eclectic ‘anti-psychiatry’ movement in the 1960s challenged the ‘Whiggish’ interpretation of history. Turning the historiography on its head, they framed the growth of psychiatry within a more sinister social constructionist ideology. Rather than signifying medical progress, they argued that the growth of psychiatry and the adjoining rise of the lunatic asylum represented a regressive development. Psychiatry’s emergence enabled a politically motivated opportunity for social control via the incarceration and silencing of ‘the mad’.Footnote ¹¹

Building upon whilst also moving beyond this binary dichotomy, subsequent histories of madness and psychiatry have tended to concentrate more on the practice of mental health. These works focus on how past societies treated those deemed to be mentally ill alongside attempts to uncover the experiences of ‘the mad’. It would be remiss not to mention Roy Porter’s influential urge in the mid-1980s to write a more patient-centred medical history ‘from below’.Footnote ¹² On both sides of the debate, those who defended psychiatry and those critical of it, the history of madness regularly operated according to a ‘top-down’ framework. The voices and experiences of ‘mad people’ remained largely ignored. Building on the burgeoning field of social history, Porter started to devote closer attention to and appreciate ‘mad people’ via their own words and perspectives.Footnote ¹³ It is within the evolution of an increasingly versatile, non-binary and multidimensional biopsychosocial history of mental health that I now consider the seven works under review.Footnote ¹⁴

This review begins with a recent publication specifically aimed at newcomers to this subject: Paul Fallon’s Madness: A Biography. At just 168 pages and published as part of Macmillan International’s Higher Education series, Fallon’s succinct monograph is a highly readable introduction for inexperienced researchers of mental health. As a Senior Practitioner for Nursing and Lecturer in Mental Health at the University of Salford, Fallon is ideally placed to provide seven concise chapters focusing on the most common and severe mental health problems that practitioners continue to encounter today. These conditions include anxiety, depression, dementia, eating disorders, psychosis, bipolar disorder and dual diagnoses. Synthesising existing published research, these chapters provide concise biographical overviews of each condition, devoting attention to its symptoms and treatment throughout history. They also discuss culture, regularly integrating artistic representations of the diagnoses in literature and film. To help engage his intended younger audience, Fallon also utilises famous contemporary celebrities as individual case studies.

Fallon uses his seven chapters to substantiate the claim that ‘mental health problems are as old as humanity itself’.Footnote ¹⁵ Fallon’s book emphasises a critical theme evident throughout the reviewed books and the broader historiography. Mental health and ill health fluctuate over time. They remain influenced by broader socio-cultural and medical values, and the prevailing political context. Fallon’s work should be judged on its own merits. The book succeeds in providing a very readable introduction for the uninitiated. Whilst Madness: A Biography will not tell experienced historians anything new, its undoubted strength lies in being read as a primer. It will be a useful addition to college-level and first-year undergraduate university reading lists, which are already well equipped with effective primers on the subject.Footnote ¹⁶ Similarly, the chapters on individual conditions can provide a helpful starting point before critically exploring biographical histories of diagnoses in further detail.Footnote ¹⁷

The multi-authored Madness: History, Concepts and Controversies from Routledge’s History of Psychology series provides another broad introductory text to the history of madness. Reflecting the interdisciplinary nature of the study of mental health history, authors Philip John Tyson, Shakiela Khanam Davies and Alison Torn are psychologists by training. Aimed again at newcomers to the topic, their research provides a more comprehensive account of madness than Fallon’s text, with an increased critical analysis of mental health. The monograph has three distinct parts. The first section presents an effective synthesis detailing the broad chronological history of mental health from prehistoric times to the present day. The second section provides a more socio-political appraisal of mental health with a discussion of the origins and cultural nature of contemporary mental health. The book’s third and final section discusses long-standing ‘live issues’. It considers the continued difficulty in adequately defining mental illness and how racial and class disparities continue to impact the delivery and reception of mental health services. These three sections, containing numerous bite-sized chapters, provide some of the best available introductions to these vast and complex areas.

This work avoids the jarring writing that can sometimes accompany multi-authored works and is immensely readable. It succeeds as a thought-provoking survey of a complex topic. The authors effectively explain how broader socio-political and cultural values have consistently shaped responses to and experiences of mental illness throughout history. Although the book’s primary audience is undergraduate psychology students and lecturers, it also offers historians valuable insights. It will perfectly complement the growing number of History undergraduate and postgraduate modules dedicated to mental health. For example, the study contains numerous noteworthy pedagogical elements. This feature includes an annotated recommended reading list at the end of each chapter, which respects the vast diversity of viewpoints on a particular topic, as well as suggested exam questions and potential teaching activities. I also commend the effective use of tables. Teaching and researching the history of madness can be challenging due to its complexity and contentious nature. The book’s tables effectively explain the four humours, the evolution of diagnostic categories across the various DSMs, psychopharmaceutical medication, Freudian theory and anxiety-related faulty thinking processes. They provide the reader with clear and concise overviews of these intricate subjects.

Rather than relying on primary archival research, both of the above works ably synthesise existing research. They offer a stepping stone to more critical engagement with the history of mental health. Sources in the History of Psychiatry, from 1800 to the Present provides an opportunity for further exploration. Two specialist historians of medicine, Chris Millard and Jennifer Wallis, co-edit this collection of essays published within Routledge’s Guides to Using Historical Sources series. The breadth and depth of this collection are a testament to the evolution of the wider historiography of psychiatry and its expansion beyond the prior predominance of the eighteenth- and nineteenth-century lunatic asylum.Footnote ¹⁸ The book includes academic contributions discussing the wide variety of source material available to historians. The authors of each chapter provide an analysis of specific primary sources, offering a critical discussion of their historical context and guidance on how to navigate them effectively. Sources under discussion include asylum records, photographs, material culture, literature, legal sources, post-mortem records, artwork, literature, film, medical journals, public enquiries and oral histories. This book offers accessible overviews of these materials and provides a critical analysis of their benefits and flaws. The eclectic mix of cultural and non-printed sources speaks to the exciting avenues now available to historians of mental health.Footnote ¹⁹

The book discusses psychiatric sources via a national framework by concentrating on Britain and British sources. This focus helps to achieve a tight and coherent structure. Sloan Mahone, a specialist in the history of psychiatry and neurology in East Africa, offers a distinct and valuable perspective with a chapter on Britain’s imperial past and its impact on psychiatry in colonial territories. Mahone’s chapter outlines how imperialism and political power influenced the delivery and experience of mental healthcare. The essay effectively highlights how studying the history of psychiatry in a colonial context evidences the abuse of power by imperial medico-legal authorities who pathologised colonial subjects. This politicisation of psychiatry led to exploitation, marginalisation and violence. This essay provides a rare and helpful introduction for those interested in better understanding this important topic. The chapter introduces historians to the sensitivities and complexities of investigating cross-cultural diagnoses and accessing and analysing overseas sources.Footnote ²⁰

Chris Millard’s essay on British medical journals explains that most of these vital research resources have been digitised and can be accessed remotely. Indeed, five of the book’s thirteen chapters are available to read via open access. This increased accessibility of historical sources relating to mental health reflects recent endeavours dedicated to the digitisation of psychiatric archival records.Footnote ²¹ Previously, it was not uncommon for disorganised mental health sources, such as the archives of lunatic asylums, to be discarded or held in remote and unsuitable premises.Footnote ²² Thanks to the financial backing and efforts of organisations such as the Wellcome Trust, many mental health institutions and charities are now increasingly available online. This concerted effort to preserve and distribute sources again speaks to the progression and growing esteem of the history of mental health as a worthwhile field of enquiry. Nevertheless, confidential documents relating to individual patients are usually restricted under a one-hundred-year embargo. As the twenty-first century unfolds, a wide range of preserved twentieth-century records will become available to historians of mental health. This development will help to redress the existing but understandable dominance of studies dedicated to the eighteenth and nineteenth centuries.

The collection’s first essay on the asylum records of the Royal Edinburgh Hospital reflects the traditional focus on institutions within the history of medicine. Numerous methodological articles have discussed how to traverse hospital and lunatic asylum records.Footnote ²³ Chris Sarg, Cheryl McGeachan and Chris Philo provide a concise and knowledgeable overview of this established research area, explaining how to integrate quantitative analysis with qualitative case studies. The authors emphasise patients’ diverse and multidimensional experiences. Rather than interpreting mentally ill patients as passive recipients within clinical settings, the authors urge their fellow historians to consider them as socially active participants able to negotiate their identities and experiences. The authors rightly note the need to reflect on the individual’s perspective, including their agency and broader connection to the political, social and cultural world inside and outside the asylum. The advent of subscription genealogy websites provides a ‘rich trove’ of exciting research avenues to help flesh out a patient’s life story.Footnote ²⁴ It should also not be lost on us that mentally ill people in the past were not exclusively defined by their mental health diagnosis.Footnote ²⁵ I agree with the authors’ arguments that studying patients’ lives before and after institutionalisation can help foreground this important reality.

Two essays offer ideal introductions to those interested in better understanding and utilising ‘survivor research’. I found Steffan Blayney’s essay, ‘Activist Sources and the Survivor Movement’, particularly striking. Despite the enthusiasm for Porter’s patient-centred history ‘from below’, the legitimate accusation remains that archival research replicates inherent power imbalances. Self-authored historical works by mentally ill individuals were often disproportionately well educated in comparison to the ‘poor and unlettered’ who did not leave behind autobiographical testimonies.Footnote ²⁶ Patient-centred histories remain difficult to achieve. Even when discussed and quoted by legal and medical practitioners, patients can still be objectified and interpreted by observers in more traditional printed sources such as asylum records.Footnote ²⁷ Blayney promotes a radical shift in perspective, focusing on grassroots organisations founded by psychiatric survivors. This aligns with the global Mad Studies network. This social justice initiative heavily critiques the biomedical approach to psychiatry and pursues a rights-based perspective by centring the voices of survivors and service users as primary narrators.Footnote ²⁸

As Blayney points out, uncovering this historical perspective can be challenging owing to the relative scarcity of sources. Nevertheless, Blayney urges readers to think critically about ‘unexplored source bases’, including potential source materials created by ‘service users’. This includes, for example, anonymous scrap notes often found within asylum archival records.Footnote ²⁹ As Blayney makes clear, one of the most accessible ways to hear the viewpoint of ‘mental health service users’ is to conduct in-person interviews. Victoria Hoyle’s chapter on ‘Oral History in the History of Psychiatry’ further explores this research resource for writing histories of mental health. Like Blayney, Hoyle promotes oral history as a valuable historical method to help redress the power imbalance inherent in mental health archives by better enabling ‘the mad’ to become the central narrator in telling their own history.Footnote ³⁰ Ultimately, the chapters in Sources in the History of Psychiatry provide a valuable research guide to historians of mental health, ranging from undergraduate students to professional historians. In addition to this core purpose, essays within the edited collection complement single case study monographs driven by archival research. Three such works constitute the remainder of this review.

Dillon J. Carroll’s Invisible Wounds: Mental Illness and Civil War Soldiers analyses Union and Confederate servicemen who suffered emotional trauma resulting from their war service in the American Civil War (1861–5). Carroll successfully integrates various literary and archival sources, including correspondence, diaries, published primary accounts, lunatic asylum records and war pension records, to create a comprehensive narrative. The integration of these sources enables Carroll to tell a multilayered story involving soldiers, ex-servicemen, doctors and local communities across eleven thematic chapters. I echo the scepticism of other reviewers regarding Carroll’s contention that African American soldiers experienced less combat-related trauma in comparison to white soldiers. This claim is based on their underrepresentation in institutions.Footnote ³¹ Nevertheless, this book provides devastatingly humane and unflinching accounts of mental suffering. Invisible Wounds contributes to the history of mental health by emphasising how stressful life events such as war and violence can induce or be a precursor to mental suffering. Recognising the need to appreciate individual suffering more fully, I particularly admired Carroll’s inclusion in his epilogue of biographies of the men cited in the main body of the text.

Invisible Wounds joins an established literature that evaluates combat and its psychological impact on soldiers and their families. The American Civil War and the First World War are two of the most studied conflicts within this sub-field of mental health history, owing to the participation of mass citizen armies in increasingly industrialised warfare.Footnote ³² In addition, both conflicts occurred during two centuries when Western societies increasingly provided state-funded welfare to veterans and recognised and engaged with psychiatry and neurology. These developments helped to ensure the production and survival of medico-welfare documents. Echoing several other cognate histories of these two conflicts, Carroll offers a ‘hybrid study’ via the lens of military history, the social history of medicine, family history and institutional history to unearth both the psychological impact of mass violence and how conflict can shape broader socio-medical understandings of mental health. Carroll’s engaging study signposted to me potential future research avenues to explore within this already well established area of research. This fresh exploration could include, for example, the long-term influences of war service on the mental health of ageing veterans and their experiences decades after their war service.

The final texts under review constitute impressive and original publications, tackling multilingual sources held in archives and libraries across multiple nations: Ana Antić’s analysis of mental healthcare during Yugoslavia’s socialist period (1945–92) and Emily Baum’s study of madness and psychiatry in early twentieth-century Republican China (1901–37). The publisher of Antić’s Non-Aligned Psychiatry in the Cold War: Revolution, Emancipation and Re-Imagining the Human Psyche necessitates a brief mention. Since 2015, Palgrave Macmillan has published numerous monographs and edited collections within its Mental Health in Historical Perspective series.Footnote ³³ This specialist series, alongside the publication of cognate articles within the History of Psychiatry journal since its founding in 1990, again attests to the development and maturation of the history of mental health as an established and distinct field of historical research.

Non-Aligned Psychiatry in the Cold War underscores the value of mental health histories as unique contributors to broader national histories. Antić’s consideration of socialist psychiatry provides distinctive insight into Yugoslavia’s socio-cultural, political and even military history. The latter is approached in the seventh chapter on combat-related trauma. I found this chapter’s focus on war trauma and disability pensions from the end of the Second World War until the turn of the twenty-first century fascinating. Antić’s analysis of the former Yugoslavia, Serbia, Croatia and Bosnia-Herzegovina provides historians of war trauma and veterans’ welfare with an intriguingly complex case study to consider and engage with. Antić’s chapter emphasises how veterans’ pensions for mental trauma and their social standing in post-war societies are intrinsically linked to nation-building and the politicisation of war memory.

Antić’s analysis of a volatile period in Yugoslavia’s history effectively demonstrates that mental health does not operate in a vacuum. Instead, the national socio-cultural and political context shaped it. By evidencing the social disparities and power imbalances between practitioners and patients, Yugoslavia echoes the Western capitalist case studies that otherwise dominate the historiography. Yet, the book also challenges potential preconceptions, particularly concerning the politicisation of ‘Soviet Psychiatry’.Footnote ³⁴ Antić’s focus provides a rare foray into Eastern European communist mental healthcare outside of the Soviet Union. As this book demonstrates, for example, Yugoslavia was the only socialist country that sent psychiatrists and mental health professionals to intervene in the Global South. In this sense, rather than presenting Eastern Europe as a socialist monolith, Non-Aligned Psychiatry in the Cold War convincingly develops a more nuanced portrayal of the ‘psy’ disciplines in Eastern Europe, aligning itself with recent cognate reappraisals.Footnote ³⁵ This important research complicates the perceived image of communist psychiatry as uniformly regressive, static and isolated. Despite providing the first monograph-length scrutiny of mental health in Yugoslavia, this study avoids becoming an isolated and niche national case study. Antić takes care to underscore the interventions and contributions of Yugoslavian professionals to global knowledge production. This study exemplifies how national case studies can meaningfully incorporate a transnational and global framework to benefit mental health historians.

Emily Baum’s The Invention of Madness: State, Society, and the Insane in Modern China offers the reader a similarly engaging, original and deeply researched work. Historians of mental health will again benefit from the author situating their research within a transnational context. Utilising archival records from across China and the United States, Baum’s monograph comprises seven thematic and chronological chapters. The remit of the analysis is broad. Baum makes the astute decision to utilise the Beijing Municipal Asylum as the driving narrative anchor to chart the evolution and development of Chinese psychiatry and to highlight the impact of Western psychiatric thought on domestic mental healthcare. Alongside this institutional history, Baum amalgamates bureaucratic procedures, medical encounters, family histories, public health advertisements, intellectual history, social history, legal and policy history and, like Antić, transnational perspectives. Regarding the latter, the emergence of globalisation is evident throughout. The extent of Rockefeller Foundation funding, its influence on Chinese psychiatry and the depth and detail of its surviving archival material, including gripping photographs, are some of the book’s most striking findings. Like all original histories, Baum’s initial foray into Chinese psychiatric history leaves plenty of scope for future analysis.

Each of the seven books serves its own purpose. Fallon’s work effectively introduces the concept of madness to uninitiated newcomers to the subject. Madness: History, Concepts, and Controversies provides a more critical analysis of the subject by introducing additional complex and nuanced issues, such as racial and class disparities within mental health services. Sources in the History of Psychiatry is a more focused publication aimed at specialists. Predominantly written by and for historians, this edited collection examines the advantages and limitations of various psychiatric sources. Carroll’s investigation of the American Civil War bolsters existing research demonstrating how traumatic events and mass violence can immensely impact an individual’s mental health and a nation’s understanding of mental illness. Antić and Baum shed overdue light on relatively neglected national case studies in a historiography dominated by capitalist Western territories. In tandem, these seven works exemplify the significant impact of politics on psychiatric knowledge and care. In this regard, they perfectly complement other works that evidence the profoundly political nature of madness throughout history.Footnote ³⁶ Historical research offers unique insights into the intrinsic connections between mental health and political ideologies and systems. Politics induces and aggravates mental ill health and shapes its interpretation. Historians are ideally equipped to uncover, demonstrate and explain this enduring relationship.

These seven works clarified my interpretation of what Roy Porter terms ‘the psychiatric balance sheet’.Footnote ³⁷ The history of madness, psychiatry and mental health does not reveal a ‘Whiggish’ story of unparalleled medical achievement and human progress. However, neither does it fully endorse the Foucauldian interpretation promoting the political motive for social control. Instead, they revealed to me the uncertain and uneven biopsychosocial influences on mental health across different periods. The seven works under review, which offer only a snapshot of recent historiographical developments, reflect a dynamic and evolving field of historical research. In addition to benefiting historians, mental health histories can be powerful instruments for social change. As Madness: History, Concepts and Controversies correctly notes in its preface, an effective mental health history ‘presents a historical overview of perspectives and treatment trends within the mental health arena for the reader to understand the origins of influential contemporary thought’.Footnote ³⁸

I conclude by returning to Andrew Scull’s description of the writing of mental health history as a ‘Sisyphean Task’.Footnote ³⁹ The immense scale of the task should not deter historians from committing themselves to this valuable and fascinating field of historical enquiry. Instead, I contend that the mental health historian should embody the more optimistic and purposeful interpretation of the Sisyphean myth offered by the absurdist philosopher Albert Camus. This reframing promotes the immense value that remains attainable even when confronting impossible tasks.Footnote ⁴⁰ While appreciating that knowing the causes and experiences of mental health will never be fully achievable and universally agreed upon, a study of its history provides a unique opportunity to understand this vital issue better. Good mental health histories raise awareness of persistent issues, provide transtemporal solidarity, remind us of the lessons we may have forgotten and highlight the mistakes we continue to repeat.Footnote ⁴¹