According to this clear, readable and somewhat dispiriting book, the history of psychiatry is a chronicle of failure. Anne Harrington’s narrative pivots around ‘the biological revolution in psychiatry’ of the 1980s (the phrase is the subtitle of a famous book published in 1984), but it also goes back to the 19th century and forward to the very recent past. It gives the reader few grounds for optimism.
Harrington opens with the ‘moral treatment’ movement that prevailed in many 19th-century asylums, founded on the idea that orderliness, kindness, fresh air and simple work would restore the mad to reason. Although great cure rates were claimed at first, ultimately a veritable epidemic of insanity filled the wards to overflowing, and by the 1880s asylum superintendents in Europe were turning to basic science for answers. Physiologists conducted autopsy examinations of the brains of the hundreds of indigent patients who died within their walls and biological theories about racial degeneration, the physiognomy of mental imbalance and the inheritance of tainted blood began to take hold.
At the same time, a countermovement emerged in central Europe: Freudian psychoanalysis. By the turn of the 20th century, the psychiatric profession had polarised into two broad camps. On one side were those who subscribed to some variety of psychodynamic theory, in which environmental influences, particularly those originating