Illustrations of madness

Tavistock Classics in the History of Psychiatry, London and New York, Routledge: JOHN HASLAM, Illustrations ofmadness, with an Introduction by Roy Porter, 8vo, pp. lxiv, xi, 81, illus., £17.00. THOMAS TROTTER, An essay medical, philosophical, and chemical on drunkenness and its effect on the human body, with an Introduction by Roy Porter, 1988, 8vo, pp. xliii, ix, 203, £19.95. WILLIAM PARGETER, Observations on maniacal disorders, with an Introduction by Stanley W. Jackson, 1988, 8vo, pp. xl, vii, 140, £17.00. For the last year or two, historians of psychiatry have been experiencing an embarras de richesse in the form of facsimile reproductions of a whole series of classic texts, each with a "substantial scholarly introduction based on ongoing research". Though the model for it was developed by Hunter and Macalpine in the 1960s, this current project's rationale is in fact the elusiveness of many influential works: published in small numbers and then never reprinted, these failed to receive the thorough analysis which modern historicism can offer. Where the original was in French or German, a contemporary translation will be used in most cases, but the first three volumes are all by English authors. Roy Porter describes John Haslam's Illustrations ofmadness (1810) as "the first book-length study of a single patient in British psychiatric history". It concerns James Mathews, a London tea-broker who-for reasons which are still obscure-had been in Paris and imprisoned during the Revolutionary ferment. Confinement after his return resulted from letters written to Lord Liverpool, accusing both him and the royal family of treachery and corruption. As Apothecary to Bethlem, Haslam was responsible for Mathews over many years, and opposed an application of habeas corpus for his release. Whilst this opposition was clearly what the Government wanted, there is no evidence that it represented anything but Haslam's honest opinion. The story turned to irony, if not farce, though, when Haslam himself was dismissed in 1816 because of the scandalous conditions of Bethlem-which were probably not his responsibility. Haslam wrote mainly to justify his own part in what had become something of a cause celbre, giving a straightforward description of the patient's beliefs and behaviour, together with lengthy quotations from Mathews's own writings. On the whole, this succeeds well enough in demonstrating that the patient experienced an elaborate delusional system, which would today be described as resulting from paranoid schizophrenia. Mathews believed that he and others were seriously affected by an immense underground machine, operated by a gang of persecutors and named, in punning neologese, the Airloom. It was inevitable that he should have looked for an explanation ofthe peculiar sensations he experienced in terms of the technology of his time; to understand this, though, does not reduce the validity of Haslam's view that he was insane. Porter makes much of the fact that the "gang" probably represented Haslam and his staff, and that ("exquisite irony") Haslam failed to recognize this, so that the verbal dual between himself and Mathews was a case offolie ai deux. That the patient was partly responsible for the doctor's dismissal was certainly an odd twist to the story, but it simply represents the well-known characteristic of paranoid psychoses that, outside the delusional area, intellect and personality mostly remain intact: as the patient in the Yorkshire asylum said-"I may be crazy, but I'm not daft". More interesting is the support that this case might give to the "recency" hypothesis of schizophrenia, since an earlier book by Haslam of 29 case-histories describes only one as experiencing auditory hallucinations (R. J. M. Howard, 'Haslam's schizophrenics' (letter), Br. J. Psychiat., 1989, 155: 265-6). That controversy, though, is far from settled yet. A fellow student of Haslam's at Bart's was William Pargeter, who eventually became a naval chaplain; his Observations on maniacal disorders of 1792 are published with an introduction by Stanley Jackson. Pargeter was not an original thinker, his ideas deriving mainly from Cullen, Battie, or Monro, but he was an observant and humane clinician. That mania and severe depression were somehow connected had been recognized earlier in the century, though the nature of this relationship remained obscure, and is not fully resolved even today. Pargeter sometimes refers to the two conditions as though they were distinct and sometimes as though they were parts of "maniacal disorders". He is very decisive, though, in his opening statement-"The chief reliance in the cure of insanity must be rather on management than medicine"-a principle which held true almost until the 1950s.