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Between Sanity and Madness
 Between Sanity and Madness
Mental Illness from Ancient Greece to the Neuroscientific Era

ALLAN V. HORWITZ, PH.D.

Board of Governors Distinguished Professor of
Sociology, Emeritus
Rutgers University
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Library of Congress Cataloging-in-Publication Data

Names: Horwitz, Allan V., author.
Title: Between sanity and madness : mental illness from ancient greece to
the neuroscientific era / Allan V. Horwitz.
Description: New York : Oxford University Press, [2020] |
Includes bibliographical references and index. |
Identifiers: LCCN 2019032581 (print) | LCCN 2019032582 (ebook) |
ISBN 9780190907860 (hardback) | ISBN 9780190907884 (epub) |
ISBN 9780190907877 (updf) | ISBN 9780190907891 (online)
Subjects: LCSH: Mental illness. | Psychology, Pathological. | Neurosciences.
Classification: LCC RC469 .H68 2020 (print) | LCC RC469 (ebook) | DDC 616.89—dc23
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This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment
for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is
designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written,
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material.
To my daughters: Rebecca, Jessica, and Stephanie
 Contents

Preface

1. Puzzles of Mental Illness

2. Before Psychiatry
3. A Biological Century
4. Freud’s Transformation of Normality
5. Mental Illness Becomes Ubiquitous
6. The Decline and Fall of Dynamic Psychiatry
7. Diagnostic Psychiatry
8. Biology Re-Emerges
9. The Successes and Failures of the DSM Revolution
10. The Past and Future of Mental Illness

References
Index
 Preface

My interest in mental illness began as an undergraduate during the late 1960s when questions
about this topic were prominent aspects of the youth culture. At the time, the work of such
figures as Ken Kesey, R. D. Laing, Thomas Szasz, and Erving Goffman were widely read and
discussed. When I entered graduate school in sociology at Yale in 1970, I encountered far more
conventional, but equally fascinating, views of psychiatric disorders. I was exposed to the
rigorous and pathbreaking sociological research of Sandy Hollingshead and Jerry Myers about
how factors such as social class and family structure profoundly shaped definitions of and
responses to those who were perceived as mentally ill. In addition, Donald Black’s innovative
studies of law and social control, which relied on a huge range of cross-cultural and historical
material, provided a model of inquiry that I have tried to emulate ever since. My own work
focused on the then-new topic of how social network structures influenced the processes through
which people came to enter psychiatric treatment. My first book, The Social Control of Mental
Illness (1980) attempted to generalize the findings from my thesis about how individuals in New
Haven defined their conditions and sought psychiatric help to a far broader range of settings.
After graduate school, I joined the faculty of the Sociology Department at Rutgers University,
which I never left. A few years after my arrival, I experienced an unusually rare stroke of luck.
David Mechanic, probably the foremost medical sociologist in the world, moved to Rutgers and
we became close collaborators. I was well-versed in David’s scholarship but had no idea that he
was also an extraordinary institution builder. In 1985 he established the interdisciplinary Institute
for Health, Health Care Policy, and Aging Research (IFH), which strongly influenced my
subsequent work.
One of the core members of IFH was the historian Gerald Grob, whose prolific studies on
American psychiatric history and policy had a major impact on my own writings. I was fortunate
to collaborate with Gerry on a number of projects before his untimely death in 2015. This book is
deeply indebted to Gerry’s scholarly vision and perspective. The postdoctoral program in mental
health at IFH was another major inspiration for my research. Gerry’s presence attracted many
leading young historians of mental illness including Elizabeth Lunbeck, Nancy Tomes, and the
late Jack Pressman, all of whom became major figures in this field. The postdoctoral program
also led to my collaboration with the extraordinary theorist of mental illness Jerry Wakefield,
with whom I co-authored two books, The Loss of Sadness (2007) and All We Have to Fear
(2012) as well as a number of articles and chapters. Jerry’s brilliant thought has infused my
writings for the past quarter-century. More recently, I have been fortunate to work with another
former postdoc, historical sociologist Owen Whooley, who is producing dazzlingly insightful
work on the history of psychiatric knowledge in the United States. IFH also brought me into
contact with a wide range of interdisciplinary researchers including Deborah Carr, Stephen
Crystal, Peter Guarnaccia, Ellen Idler, Howard Leventhal, Jane Miller, Kathleen Pottick, Sarah
Rosenfield, Keith Wailoo, and Jamie Walkup. My colleague in the Rutgers Sociology
Department Eviatar Zerubavel provided a model of creative sociological thinking. All of these
scholars not only provided an incredibly congenial work environment but also models for
imaginative and innovative scholarship.
In addition to the many wonderful faculty and postdocs that I encountered at Rutgers, I have
been fortunate to work in a field—the social and historical study of mental illness—that is filled
with exceptional scholars. Those who have had especially important influences on this book
include David Healy, George Makari, Andrew Scull, Edward Shorter, and the late Roy Porter.
This book is the result of these many diverse sociological, historical, anthropological, and
philosophical influences. Consequently, it is unusual in a number of ways. Although the volume
is organized chronologically, it does not adhere to a traditional concentration on a single culture
or historical era. Instead, it considers how various societies have defined madness and sanity,
viewed the relationship between psychic and physical disorders, and understood the origins and
appropriate responses to mental illnesses. Bookended by an analytic introductory chapter and a
synthetic concluding one, the first three substantive chapters involve understandings of mental
illness in Ancient Greece and western European societies while the following five chapters focus
on American psychiatry. Many of these chapters draw upon my previous writings, which are
noted in the Acknowledgments section in each chapter.
Terminology represents a great challenge in writing about mental illness. Terms such as
“mad” and “insane” that were historically descriptive labels have become highly pejorative. I
continue to use them, despite the considerable baggage they carry, because they convey
meanings that have traditionally accompanied understandings of mental illness. In addition, I use
the more general terms “mental illness” and “mental disorder” interchangeably although others
employ them more distinctively.
Finally, I have been fortunate to continue my affiliation with Oxford University Press. I am
especially grateful to my editors, Andrea Knobloch and Jacqueline Buckley, for their support
throughout this project. I am also indebted to the anonymous reviewers of this manuscript for
their many insightful suggestions, which have resulted in an immensely improved book.
 1
Puzzles of Mental Illness

[In ancient Israel] it was proposed that a person who wandered about alone at night, who spent the
night in a cemetery, or who tore his garments and destroyed what was given to him might be
considered deranged—if such behavior appeared irrational. However, it was pointed out that otherwise
normal persons could also behave in this way, e.g. one who spent the night in a cemetery might have
done so to practice magic, or that another who tore his clothes might have done so in a fit of anger, or
because he was a cynic philosopher exhibiting his contempt for material things.
—George Rosen, Madness in Society (1968)

Every society, regardless of time or place, regards some of its members as mad. Typically, this
label has been reserved for a small number of seemingly senseless behaviors. For example, the
Native Alaskan term for crazy, “nuthkavihak,” refers to “such phenomena as talking to oneself,
screaming at someone who does not exist, believing that a child or husband was murdered by
witchcraft when nobody else believes it, believing oneself to be an animal . . . killing dogs, and
threatening people.”1 Similarly, the Kalumburu people in Australia use the word “wambaba” to
mean mad or crazy; it refers to “an excited or assaultive individual who talks strangely, swears a
lot, forgets his manners, opens his bowels where people live, knocks over his water holder, or
runs off in fright to the bush. He behaves in a highly disturbed and incomprehensible way.”2
Early 20th-century German psychiatrist Karl Jaspers comparably isolated “incomprehensibility”
as the most distinctive aspect of madness: “All the sudden impulses, the unfathomable affect and
lack of affect, the sudden pauses in conversation, the disconnected ideas. . . . Some call these
actions eccentric, silly. But with all these terms we are at the end of the day saying the same
thing: The common factor is ‘incomprehensible.’ ”3 The inexplicable aspects of madness contrast
with the socially shared conceptions of reality that mark sanity.
Present views of what constitutes a mental illness encompass such unfathomable conditions
but far more as well. Despite general agreement regarding the pole of madness, huge disparities
exist on where dividing lines should be placed between it and sanity and even if there is any clear
demarcation at all. The range of current mental disorders includes, among much else, depression,
anxiety, post-traumatic stress disorder (PTSD), various addictions, attention-deficit/hyperactivity
disorder (ADHD), and numerous personality disorders. The most highly regarded surveys
indicate that a quarter of the U.S. population experiences some mental illness in any particular
year and well over half at some point in their lives.4 Other, more comprehensive, studies show
that two-thirds of people will become mentally ill over their lifetime.5 Recent cohorts of young
people report especially vast amounts of disorder: in the early 21st century, half of American
adolescents seemingly have some mental illness by age eighteen.6 Global data from the World
Health Organization indicate that mental illnesses now account for more years of disability than
any other disease category.7
Enormous historical and cultural disparities also exist regarding what sort of authority should
respond to mental illnesses. Dominant current practices—following a long tradition—regard
these conditions as brain-based defects that medical and other mental health professionals should
treat. In other times and places, however, similar behaviors have been viewed as sins that require
confession, possessed states in need of exorcism, crimes that entail punishment, or creative
inspirations that should be cultivated.8
While various groups provide an extensive array of answers to questions about the nature of
mental illness and its boundaries with sanity, all have confronted the same issues. What
distinguishes mental illnesses from other sorts of devalued conditions and from normality?
Should medical, religious, psychological, legal, or no authority at all respond to the mentally ill?
Which factors lead people to become mad? What treatments might help them recover? The
various responses that societies have provided to these puzzles are both widely divergent and
surprisingly similar to current understandings.

Distinguishing Sanity from Madness

All groups face the challenge of defining what aspects of madness distinguish it from normal
actions on the one hand and other sorts of deviant behaviors on the other. A debate among
Talmudic scholars two millennia ago illustrates the difficulties that arise in isolating the
distinctive qualities of insanity:
It was proposed that a person who wandered about alone at night, who spent the night in a cemetery, or who
tore his garments and destroyed what was given to him might be considered deranged—if such behavior
appeared irrational. However, it was pointed out that otherwise normal persons could also behave in this way,
e.g. one who spent the night in a cemetery might have done so to practice magic, or that another who tore his
clothes might have done so in a fit of anger, or because he was a cynic philosopher exhibiting his contempt
for material things.9

For these ancient observers, the characteristic feature of mentally ill people did not lie in their
behavior. Instead, it involved the absence of contextually appropriate reasons for their actions.
The mad often wandered at night, slept in cemeteries, or tore their clothes off. Yet, sorcerers,
angry people, or philosophers also did the same things. The essential difference was that the
latter had socially comprehensible motivations—practicing magic, fits of anger, philosophical
principles—for their behaviors. In contrast, observers could not connect the activities of the
mentally ill to any socially explicable purpose. Inferences about sanity and madness, therefore,
involved whether or not actions could be linked to understandable motives.
Two thousand years later, acclaimed sociologist Erving Goffman made a similar point: “The
delusions of a private can be the rights of a general; the obscene invitations of a man to a strange
girl can be the spicy endearments of a husband to his wife; the wariness of a paranoid is the
warranted practice of thousands of undercover agents.”10 Judgments about whether some
behavior is deluded or justified, obscene or romantic, and paranoid or reasonable require
knowledge of relevant contextual information. When observers can find a socially plausible
reason for some action, they do not define it as a sign of mental disturbance.
The Sebei people of East Africa provide an example of how groups differentiate mental illness
from other devalued behaviors such as criminality, drug use, intellectual deficiency, bad
manners, or ignorance. Anthropologist Robert Edgerton recounts a dialogue among a group of
Sebei who are discussing the behavior of a young man that they observed talking nonsense,
making abrupt and jerky movements, flapping his arms like a bird, and giggling like a child:
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SALIMU: He is a strange boy.
SAYEKWA: He is a foolish boy. Why does he behave that way?
SALIMU: He may be mad or he may be foolish (mentally retarded).
SAYEKWA: It could also be bewitchment or a fever or something like a fit. . . .
INTERPRETER: There is something wrong. People here smoke bhang. Perhaps he may be a bhang
man.
SAYEKWA: No. I don’t think that. He is more like he is crazy.
SALIMU: I think he may be a fool.
INTERPRETER: It is impossible to know without knowing about his family. We could ask one of
these people about him.
ANTHROPOLOGIST: What is the difference between a fool and a madman?
SALIMU: A fool was born without sense. A madman becomes senseless because of a disease or
witchcraft. We would have to know his history to tell about this young man.11

This debate shows the typical constructions involved in making attributions of insanity.
Observers use factors such as family history, biographical circumstances, and situational
contingencies to decide among the various possible interpretations of inappropriate behaviors.
Before participants use mental illness to explain some strange behavior, they rule out other
designations such as foolishness, bewitchment, psychotropic drug use, or epilepsy. The answers
to the questions that the Sebei pose also imply the kind of response that should be made to the
strange behavior. If he is a “bhang man,” then the village equivalent to the police might be
called. If he is a fool, he was born that way and no remedies are available. If, however, the boy is
deemed to be mad, they might summon a witchdoctor to expel the possessing force. Similar
distinctions persist in current psychiatric diagnostic manuals.

The DSM Definition of Mental Disorder

Discussions of the nature of mental illness mark all societies, including our own. Consider the
“official” designation of mental disorder that is found in the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5):
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s
cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or
developmental processes underlying mental functioning. Mental disorders are usually associated with
significant distress or disability in social, occupational, or other important activities. An expectable or
culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental
disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily
between the individual and society are not mental disorders unless the deviance or conflict results from a
dysfunction in the individual, as described above.12

Much like the Sebei, the DSM strives to isolate the particular qualities that distinguish mental
disorders from other kinds of devalued conditions and from normality. Its characterization has
four central aspects, two that try to express what mental illnesses are and two that attempt to
delineate them from non-disordered behaviors.

Dysfunctions
At the heart of the way that the DSM identifies a mental disorder—comparable to the various
definitions of premodern groups—is the presence of a “dysfunction in the psychological,
biological, or developmental processes underlying mental functioning.” Although the definition
does not specify what a “dysfunction” is, the term presumably indicates that some process is not
simply undesirable or rare but that something has gone wrong with mechanisms involving
cognition, emotional arousal, perception, memory, and the like.13 The resulting symptoms are
neither explicable responses to circumstances nor culturally normative. The definition does not
stipulate whether dysfunctions involve defective brain or psychic processes but allows for either
sort of account. Nor does it mention what qualities mark the appropriate functioning of
psychological, biological, or developmental processes.
The DSM’s placement of dysfunction at the heart of its definition of mental disorder echoes a
long historical tradition. For example, a renowned Ancient Greek physician, Aretaeus of
Cappadocia (~2nd century AD), described melancholics in these terms: “Sufferers are dull or
stern: dejected or unreasonably torpid, without any manifest cause.”14 Here, “without any
manifest cause” implies that melancholic symptoms result from some inner dysfunction as
opposed to reasonable grounds for melancholy such as the loss of an intimate relationship,
economic catastrophe, or diagnosis of a serious physical disease. Two thousand years later, one
of the founders of 19th-century biological psychiatry, German psychiatrist Wilhelm Griesinger
(1817–1868), made a comparable distinction between identical symptoms that result from a
dysfunction or from some appropriate external cause:
The melancholia which precedes insanity sometimes appears externally as the direct continuation of some
painful emotion dependent upon some objective cause . . . , e.g. grief, jealousy; and it is distinguished from
the mental pain experienced by healthy persons by its excessive degree, by its more than ordinary protraction,
by its becoming more and more independent of external influences, and by the other accessory affections
which accompany it.15

Symptoms that are rooted in external situations are “healthy”; those with disproportionate
severity or duration to their generating contexts indicate insanity. The DSM follows this
enduring line of thought, emphasizing how only symptoms that reflect an internal dysfunction
rather than some appropriate situational cause mark some disorder. If nothing is wrong with
someone’s inner functioning, they do not have a mental illness.
As the debate among Talmudic scholars shows, it is often difficult to distinguish conditions
that arise from a dysfunction or from some other reason. Consider the case of Michael Phelps,
who has won more Olympic medals than any athlete in history. When he was nine years old,
Phelps received a diagnosis of ADHD, which is made when someone is unable to focus, sit still,
or concentrate, presumably because of some inner dysfunction. “I was told by one of his teachers
that he couldn’t focus on anything,” his mother recounts.16 This suggests that Phelps had some—
possibly biological—inability to pay attention. Yet, he had no comparable problems of focus
when it came to his swimming. “For the past 10 years, at least, he’s never missed a practice,”
Phelps’s mother recalled. “Even on Christmas, the pool is the first place we go, and he’s happy
to be there.” Did Phelps have a dysfunction or, instead, a compelling competing interest that
preoccupied him?17 Alternatively, he could have been one of the youngest children in his class
so that his relative immaturity put him at greater risk for receiving an ADHD diagnoses.18 All
groups have faced the intrinsic uncertainties in distinguishing behaviors that stem from
dysfunctions or from other reasons.
Pederasty—sexual relations involving adult men and prepubescent boys—provides another
example of the problems involved in making decisions about the presence of some dysfunction.
Our culture views pederasty as perhaps the most reviled form of sexual behavior. The DSM-5
defines adults who are aroused by having sex with children (generally thirteen years or younger)
as having a pedophilic disorder, which involves inappropriate targets of sexual preferences.19 In
our society, some inner dysfunction is likely to motivate pedophiliacs’ anomalous sexual
preference because their desires persist despite strong social sanctions.20
Yet, many cultures have institutionalized sexual relationships between older men and
prepubescent and adolescent boys. Most notably, the ancient Greeks esteemed intergenerational
erotic ties among males, which were deeply embedded in their civic life: “A whole philosophy
was built up round [pederasty], based on the idea that the lover was the educator and military
trainer and partner of the beloved, and would do everything to earn his admiration,” historian
Michael Grant notes.21 Involvement in culturally approved man–boy sex among the ancient
Greeks (and other societies that do not condemn such relationships) would rarely stem from
defective sexual arousal mechanisms but instead are learned and culturally approved practices.
The Siwan group in North Africa provides an example: “All men and boys engage in anal
intercourse. Males are singled out as peculiar if they did not do so.”22 In such groups, a
dysfunction is unlikely to underlie pederasty. Therefore, similar modes of sexual attraction are
likely to stem from dysfunctions in groups where they arise in the face of harsh disapproval but
not in others where they are customary and, sometimes, even mandated.
The example of pederasty illustrates some of the many issues raised by the requirement that a
mental disorder must stem from some dysfunction: is it possible to know what the appropriate
functions of psychological mechanisms are without reference to cultural values; can a
mechanism that is dysfunctional in some groups be functional in others; do many negatively
valued behaviors such as extreme jealousy, hatred of outgroups, fear of strangers, or intercourse
with pubescent adolescents stem from natural, rather than dysfunctional, processes?23 Such
concerns raise the question of the objective or value-laden nature of dysfunctions. “The most
fundamental issue, and also the most contentious one,” psychiatrist Robert Kendell contends, “is
whether disease and illness are normative concepts based on value judgments, or whether they
are value-free scientific terms; in other words, whether they are biomedical terms or socio-
political ones.”24 The DSM introduces a normative component into its definition through
invoking the distress or disability associated with some dysfunction.

Distress or Disability
The DSM implicitly deals with the issue of whether definitions of mental disorder are objective
or value-laden through stating that a dysfunction in itself typically does not provide sufficient
grounds to infer the presence of a mental disorder. Only dysfunctions that are “usually associated
with distress or disability” are disorders.25 Therefore, adequate characterizations of mental
disorder contain elements of both a dysfunction that involves incapacity to perform a natural
function and a cultural judgment that defines the dysfunction as undesirable. Jerome Wakefield’s
term “harmful dysfunction” captures this dual quality of mental disorder.26
The necessity of harm means that dysfunctions are not mental disorders when they are neither
distressing nor disabling. Many psychological dysfunctions—for example, persistent
depressions, crippling compulsions, or inexplicable anxiety—intrinsically entail distress. Yet,
many others do not involve any misery at all. For example, anosognosia—the unwillingness of
people to believe that anything is wrong with their minds—can characterize people with
schizophrenia.27 Or, the manic stage of bipolar disorder is marked by euphoria, seemingly
exceptional ideas, highly pleasurable behaviors, and often unusual degrees of creativity.28 The
DSM takes this into account by saying that dysfunctions that do not involve distress must entail
“disability in social, occupational, or other important activities” if they are to be considered as
disorders. In contrast to distress, which refers to the feelings of the disturbed individual,
disability often involves problems with other people such as parents, spouses, teachers, bosses,
or social control agents.
The DSM’s distress or disability constraint means that, although all mental disorders result
from some inner dysfunction, all dysfunctions are not disorders. Only dysfunctions that also have
impairing consequences for selves or others are mental disorders, presumably because it would
be pointless to be concerned with conditions that are unproblematic for both individuals and
those around them. One important consequence of this aspect of the DSM definition is that,
while dysfunctions can be grounded in universal organic or psychic processes, mental disorders
can be cross-culturally relative. Because the degree of distress or disability that any dysfunction
entails varies considerably across cultures, the definition implies that dysfunctions can be
disorders in some cultures but not in others.
Anthropologist Ruth Benedict’s “Anthropology and the Abnormal” (1934) presented the
classic statement that the concept of mental disorder is culturally relative. Benedict (1887–1948)
questioned the validity of applying Western definitions of normality and abnormality to different
cultures. Instead, she asserted that various groups around the world consider as normal and
appropriate the sorts of behaviors—paranoia, seizures, trances, and the like—that Western
psychiatry defined as abnormal. She used as an example the Dobuans of Melanesia, who display
a constant fear of poisoning that they saw as normal rather than as paranoiac. Or, she noted that
the Shasta Indians in California and the native people of Siberia did not view seizures as dreaded
illnesses but instead as signs of special connections to supernatural powers that singled out
people for authority and leadership. She also discussed catalepsy—a state that involved
trancelike states, hearing voices, losses of voluntary motion, and rigid limbs—to illustrate how
some other cultures treated as valued conditions what Western psychiatry considered as the
mental disorder of catatonic schizophrenia. “There are,” Benedict asserted, “well-described
cultures in which these abnormals function at ease and with honor, and apparently without
danger or difficulty to the society.”29
Conversely, Benedict described behaviors that were normalized and even rewarded in our
culture that would be considered mad in other cultures. Dobuans, for example, would regard a
person who was always cheerful, happy, and outgoing as crazy. Divisions between justified
suspicions or paranoia, ritualistic invocations of spirits or hallucinations, and unnaturally
prolonged or appropriate periods of grief were often blurry, tied to context, and subject to value
judgments. Normality thus resided in culturally approved conventions, not in universal biological
or psychological standards of appropriate functioning. “All our local conventions of moral
behavior and of immoral are without absolute validity,” Benedict concluded.30
Advocates of the DSM definition could use the distress or disability requirement to challenge
Benedict’s assertion that there is no validity to Western conceptions of schizophrenia because
some groups place people who hallucinate, have delusions, fall into trance states, and speak
incoherently into valued and honored social roles. From their perspective, such individuals have
dysfunctions that their cultures do not evaluate as harmful.31 The distress or disability
requirement implies that the universal aspects of dysfunctions are compatible with the culturally
relative nature of mental disorders.
Like decisions about the presence of a dysfunction, judgments about distress or disability can
be difficult to make. Take the example of the poet Emily Dickinson who, by the time she was
forty, would not leave her home and hid in her room, unwilling to see even her longtime
friends.32 Nothing about Dickinson’s circumstances could account for her refusal to walk outside
or to meet with people she had known for extended periods of time. Her extreme social isolation
seems likely to have stemmed from some inner dysfunction. Yet, it was arguably neither
distressing nor disabling. Indeed, many people regard her as the greatest American poet, largely
because of the poems she wrote during her period of seclusion. Whether her extreme fear of
going out in public or seeing friends should count as disabling or, on the contrary, a precondition
for her genius has no easy answer.
The distress or disability stipulation is a complicating factor in setting boundaries between
sanity and madness. It also raises challenging issues related to the value-laden component of
definitions of mental disorder. Both feelings of distress and social impairments often arise
because of negative societal attitudes rather than any intrinsic qualities of some dysfunction. For
example, the DSM-III diagnosis of “ego-dystonic homosexuality,” which applied to
homosexuals who were distressed by their sexual orientation, seems to result more from
individual responses to oppressive social norms than from a dysfunction.33 It shows how the
harm that some condition engenders can stem from cultural values rather than from the
dysfunction. Separating the normative from the biomedical elements of mental disorder is often
an imposing task.

Mental Disorders Are Not Explicable Responses to Circumstances

Like ancient Talmudic scholars, the DSM tries to specify what sorts of phenomena do not
constitute internal dysfunctions and so are not mental disorders. The DSM’s definition
distinguishes dysfunctions from “an expectable or culturally approved response to a common
stressor or loss, such as the death of a loved one.” This means that symptoms resembling
dysfunctions and entailing intense suffering or disability are nevertheless not disordered because
they are natural responses to circumstances.34 The definition uses “the death of a loved one” as a
model for highly distressing states that are not disordered because they are contextually
explicable. People naturally become intensely sad after someone close to them dies; their internal
functioning is appropriate, not pathological. Although such symptoms can be very distressing
and, often, disabling, they are reasonably commensurate to the severity of the situation that led to
them and, unlike dysfunctions, typically dissipate with the passage of time. In contrast, as
Griesinger noted, mental disorders arise in the absence of a suitable context or initially appear
after some precipitating event but become disengaged from their initial trigger, take on a life of
their own, and are immune to changes in external conditions.
The intense grief that psychiatrist and anthropologist Arthur Kleinman suffered after the death
of his wife illustrates this aspect of non-disordered yet highly distressing conditions.
In March, 2011, my wife died and I experienced the physiology of grief. I felt greatly sad and yearned for
her. I didn’t sleep well. When I returned to a now empty house, I became agitated. I also felt fatigued and had
difficulty concentrating on my academic work. My weight declined owing to a newly indifferent appetite.35

Kleinman’s symptoms easily meet the DSM criteria for major depressive disorder. Yet, as long
as emotions have been recorded, experiences of grief—feelings of deep sadness that follow the
death of an intimate—have been central to portrayals of basic human nature. Kleinman’s grief, as
the DSM definition recognizes, is a normal response to an intense loss. Accordingly, his distress
gradually eased over time in the absence of any treatment: “This dark experience lightened over
the months, so that the feelings became much less acute by around 6 months.”36 The intense
depressive symptoms that Kleinman and other grievers experience are not products of a
dysfunction but are explicable in light of their circumstances of loss.
Like Kleinman’s grief, anxious emotions that could indicate a dysfunction when no danger is
present are appropriate in perilous situations. Psychiatrist Kenneth Kendler uses the example of a
mountain climber who suffers a full-blown panic attack when he loses his grip and falls before
his rope catches him. “A panic attack,” Kendler explains, “is not—in and of itself—
psychopathological. It only becomes pathology when it occurs in certain contexts—at times and
in places when it should not. Thus the diagnostic status of panic disorder is inherently contextual.
It is not a disorder in and of itself but only in certain contexts.”37
As is the case with grief, not panic symptoms alone but their relationship to the circumstances
in which they emerge accounts for the distinction between “expectable” panic attacks that are not
disorders and “unexpectable” ones that are disorders. Identical symptoms that are explicable in
one context, such as falling down a mountain, are signs of a mental disorder when there is no
contextually appropriate explanation for them. “Most negative mental states such as sadness,
despair, anxiety, fear, agitation, and anger,” Wakefield and psychiatrist Michael First observe,
“are not abnormalities but normal responses to life’s vicissitudes.”38
PTSD illustrates some of the nuances involved in distinguishing “abnormalities” from “normal
responses to life’s vicissitudes.” It definitionally arises from exposure to some traumatic event
and so might seem to be an “expectable” response to a stressor and, therefore, not a dysfunction.
However, the characteristics that Griesinger noted in regard to depression—“excessive degree,”
“more than ordinary protraction,” and “becoming more and more independent of external
influences”—suggest that continuing symptoms of PTSD have become detached from their
initial generating context. Their intrusive, recurrent, and involuntary nature indicates that an
extreme environmental stressor has led the natural functioning of memory mechanisms to
breakdown.39 Because such symptoms are also almost invariably associated with distress and/or
disability, PTSD would be a genuine mental disorder and not simply a contextually explicable
response to circumstances. Needless to say, it is often difficult to distinguish behaviors that are
“dysfunctional” from those that are “expectable” reactions to given contexts.

Mental Disorders Are Not Forms of Social Deviance

The DSM definition strives to separate mental disorders not just from contextually explicable
behaviors but also from “socially deviant behaviors” and “conflicts between individuals and
society.” Often, drinking heavily, persistently using culturally devalued drugs, engaging in
unusual sexual activities, or offending the wrong kind of person are types of deviant social
behaviors: violations of social norms that define standards of proper behavior. Likewise, people
who disregard social conventions, hold divergent political beliefs, or have disreputable lifestyles
might develop conflicts with society. The DSM definition distinguishes such nonconformists
from those who have dysfunctions that lead them to suffer negative effects such as persistent
abuse of addictive substances, compulsive pursuit of activities that harm them, or an inability to
refrain from engaging in socially disvalued activities. The latter would have mental disorders
only when some internal dysfunction leads to their distressing or disabling conditions.
This aspect of the definition again contains echoes of the Sebei, who divide madness from
deviant behavior: “Respondent after respondent qualifies his description of a psychotic behavior
by saying ‘without reason.’ That is, murder as such is not psychotic—only murder without some
good reason is psychotic. The same thing is true of every other behavior cited.”40 The DSM
strives to separate rule-violating behaviors that entail individual responsibility from those that
stem from a dysfunction and therefore should be treated rather than punished.
Such decisions are often controversial. Consider the case of Adam Lanza, who killed his
mother, twenty elementary school children, six staff members, and then himself in Newtown,
Connecticut, in 2012. Like Emily Dickinson, his life was marked by extreme social isolation:
“Lanza seemed to have no friends or people he could turn to for support or assistance and did not
appear to have any enjoyment of life.”41 Unlike Dickinson, Lanza was obsessed with previous
mass shootings and spree killings. Many people would agree with Lanza’s father, who stated
“You can’t get any more evil.”42 For him, Lanza’s actions were not the senseless acts of a
madman but those of a depraved killer. Current clinicians would be hard pressed to make more
informed decisions than the Sebei about whether Lanza was a mass murderer or a victim of some
inner dysfunction.
Hoarding disorder, which was added to the DSM in 2013, shows the often value-laden nature
of decisions that try to distinguish mental disorders from conflicts between individuals and
society. The essence of this condition is “persistent difficulties discarding or parting with
possessions regardless of their actual value.”43 Hoarders typically accumulate so many items that
they and others have difficulty navigating their living spaces. Individuals themselves are
typically not troubled by their condition unless someone tries to stop their hoarding.
Interventions typically arise after complaints from family members, neighbors, or public health
departments. The justification for calling their behaviors “dysfunctions” or “mental disorders” as
opposed to “conflicts between individuals and society” is unclear.
Precise lines rarely exist between dysfunctional and deviant conditions. “No other specialty of
medicine deals with diseases whose initial signs can be so easily confused with moral lapse,” an
officer at the Rockefeller Foundation wrote in 1944.44 Indeed, many particular DSM diagnoses
seem to encompass activities that were traditionally regarded as sins. Examples include
distinctions between binge eating disorder and gluttony, hypersexual disorder and lust,
intermittent explosive disorder and wrath, or narcissistic personality disorder and pride.45 To say
the least, the grounds for separating dysfunctions and, therefore, mental disorders from such
traditional vices are rarely precise. Other diagnoses, such as oppositional defiant disorder or
conduct disorder are extraordinarily difficult to separate from “conflicts between individuals and
society” as well as from delinquency and criminality.46 Moreover, such definitions diverge
widely across cultures. American psychiatrists might diagnose an unmarried woman (but not a
single man) who engages in unrestrained sex as hypomanic; the same behavior might elicit harsh
punishment in many Muslim societies and indifference in Scandinavian ones.47 Nevertheless, all
groups strive to distinguish people who are mad from those who are normal, deviant, sinful,
criminal, or prophetic, however difficult this splitting might be in practice.
The poles of madness and sanity are usually obvious; a remarkable consensus exists across
various cultures regarding what are clear cases of mental illness.48 Talmudic scholars, Sebei
observers, Australian Native People, 19th-century psychiatrists, and the promulgators of the
DSM would concur that certain kinds of unreasonable, inexplicable, and incomprehensible
actions constitute one extreme of distinctly disordered behaviors. They would also agree that
actions that are understandable responses to particular contexts represent the opposite pole of
normality.49 Yet, all of these definitions—including the DSM’s—recognize that the boundaries
between the extremes of mental health and mental illness are typically vague and fuzzy. The
concept of mental disorder, therefore, is often indefinite because the phenomena that it applies to
are themselves indefinite.50
Answers to the central questions involved in defining mental disorder—what is a dysfunction;
to what extent are the negative consequences of mental disorders direct results of dysfunctions or
of social attitudes; what standards distinguish contextually explicable from dysfunctional
symptoms; and how is it possible to separate mental disorders from other forms of social
deviance?—seem no more definitive now than they were thousands of years ago. Perhaps the
reason for this lack of progress does not lie as much in the flaws of the DSM definition as in the
intrinsically elusive and possibly insolvable nature of the question of what a mental disorder is.
While the extremes of madness and sanity are usually clear, different societies have placed
boundaries for the vast terrain of conditions that fall in between these poles in very diverse
places.

To What Extent Do Mental Illnesses Resemble Physical Ones?

One perennial issue groups have faced has been how to specify the distinctive qualities of mental
disorders. A second recurrent concern regards what kind of authority defines their nature and
controls their treatment. A particularly contentious issue has been the extent to which mental
illnesses involve somatic or psychic processes. The answer to this question typically dictates
whether mental disorders fall within medical or, alternatively, religious, legal, philosophical,
psychological, or some other jurisdiction.
The view that some organic defect lies behind madness has persisted for millennia.51 This
belief implies that mental illnesses are comparable to bodily diseases: both are biologically
grounded, subject to the laws of nature, and have qualities that are independent of individual or
cultural characteristics. Hippocratic physicians in 4th-century BCE Greece provided perhaps the
first statement of this perspective: “Men ought to know that from the brain, and from the brain
only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and
tears.”52 The idea that mental disorders are brain diseases also dominates contemporary
portrayals of mental illness. A 1999 report from the U.S. Surgeon General echoes the
Hippocratics: “It is, in fact, a core tenet of modern science that behavior and our subjective
mental lives reflect the overall workings of the brain. Thus, symptoms related to behavior or
mental lives clearly reflect variations or abnormalities in brain function.”53 The DSM, too,
implies that the ultimate benchmark for health and disorder is the same in psychiatry as it is in
physical medicine, namely, whether the individual’s mental processes are performing the
functions they are naturally designed to perform.
In the biomedical view mental disorders, like organic diseases, have properties that cannot be
reduced to individual idiosyncrasies or cultural values. “This modern history of diagnosis,”
according to historian Charles Rosenberg, “is inextricably related to disease specificity, to the
notion that diseases can and should be thought of as entities existing outside the unique
manifestations of illness in particular men and women: during the past century especially,
diagnosis, prognosis, and treatment have been linked ever more tightly to specific, agreed-upon
disease categories.”54 The symptoms of, say, depression, anxiety, schizophrenia, or bipolar
disorder, no less than those of cancer, diabetes, asthma, or malaria, can be abstracted from the
individuals who have them and studied as objects with distinct causes, courses, and outcomes.
Nosologies such as the DSM thus do not classify individuals: “A common misconception is that
a classification of mental disorders classifies people, when actually what are being classified are
disorders that individuals have,” the manual asserts.55
Because in the biomedical view mental as well as organic diseases reflect physical laws, they
operate independently of time, space, and social evaluations. For example, in 1882 famed
neurologist Jean-Martin Charcot (1825–1893) proclaimed of hysteria that “everything unfolds
according to the rules, which are always the same. . . . They are valid for all countries, for all
epochs, for all races, and are, in short, universal.”56 Similarly, Emil Kraepelin (1856–1926), the
foremost psychiatric diagnostician in the late 19th and early 20th centuries, visited Singapore to
see if Asian patients differed from European ones. He concluded that they had the same disease:
“we must therefore seek the real cause of dementia praecox [schizophrenia] in conditions which
are spread all over the world, which thus do not lie either in race or in climate, in food, or in any
other general circumstances of life.”57 Although local factors typically lead to divergent
prevalence in different settings, the core features of each mental disorder are invariant results of
natural processes.
Medicine is only one, although often the most prominent, form of jurisdiction over madness.
Benedict, for example, showed how many premodern groups place individuals who enter
possessed states that were similar to madness into valued social roles that entail exceptional
spiritual connections to supernatural powers. For a millennium in the West, religious authorities
dictated responses to the insane, which typically strove to eliminate the evil influences that
polluted them. Legal definitions, too, which place rule-violating behaviors within frameworks of
responsibility and guilt, often compete with medical authority.
Other views contend that madness should not be subject to any form of social control. Perhaps
the best-known statement of this position is psychiatrist Thomas Szasz’s assertion that the
concept of mental illness itself is a “myth.”58 Szasz (1920–2012) claimed that terms such as
“illness” and “disease” only apply to physical lesions. In contrast, mental illnesses deviate from
psychosocial norms that have no objective reality in the natural world and so reflect culturally
grounded value judgments. Hence, the notion of a “mental illness” is an inherent contradiction.
Unless they have violated some legal standard, there is no justification for exerting any form of
involuntary social control over people who are thought to be “mentally ill.” A variety of
competing philosophical, religious, legal, and other perspectives continues to challenge the
primacy of medical authority over mental illness.

What Factors Lead People to Become Mentally Ill?

A third continuing issue regards the perceived reasons for why some people become mad.
Observers have sometimes found the causes of mental illness in inner biological or psychological
forces and, at other times, in environmental, social, and cultural factors. Often, the two types of
explanations have been thoroughly intertwined.
One type of internal characterization emphasizes how some organic defect in the brain, nerves,
or other bodily systems including hormones, the digestive system, or the heart accounts for
madness. Depending on the particular time period, physiological foundations have included the
humors, constricted blood vessels, weak nerves, or deficient or excessive levels of
neurochemicals among many others. For example, 18th-century physician Nicholas Robinson (c.
1697–1775) declared that all mental disorders “from the slightest Symptoms of the Spleen and
Vapours, to the most confirm’d Affections of Melancholy Madness and Lunacy . . . are no
imaginary Whims or Fancies, but real Affections of Matter and Motion, whenever the
Constitution of the Brain warps from its natural Standard.”59 Current philosopher Paul
Churchland echoes this view: “The victims of mental illness are the victims primarily of sheer
chemical circumstances, whose origins are more metabolic and biological, than they are social or
psychological.”60 Such biological explanations typically entail medications or other
manipulations of the brain as treatments of choice. One of the few constants across history has
been the use of drugs, particularly opium and alcohol, to alleviate distress among people with
mental disorders.
While many inner interpretations ground mental disturbances in defective brain processes,
many others use psychological understandings. The Freudian emphasis on repressed memories of
childhood sexuality as causes of a variety of neuroses among adults is one prominent example of
a psychic explanation.61 Another is when cognitive distortions in information processing about
the self, the world, and the future lead to persistent negatively biased thoughts and appraisals and
consequent depression and anxiety. Current cognitive methods strive to change distorted patterns
of thinking that are presumably responsible for the presence of mental illnesses.62 They are
descendants of ancient philosophies such as Stoicism and Epicureanism, which have taught
people to use psychological techniques that distance themselves from worldly concerns as ways
to establish inner peace of mind.
Throughout history, explanations of mental disorders that rely on external stimuli stand
alongside those emphasizing internal factors. Such influences have included supernatural
interventions, witchcraft, climate, traumatic events, or problematic interpersonal relationships to
explain the emergence of mental illnesses. Many treatments of mental illness as well have
manipulated environments, often aiming to promote restrained modes of living through changing
diets, sleep patterns, and exercise routines. For example, the mental institutions that developed in
the early 19th century in Europe and the United States were based on treatments that assumed
changing surroundings would alleviate or cure madness.
Internal and external explanations often have not been regarded as mutually exclusive.
Hippocratic conceptions of mental illness, for example, focused on imbalances among bodily
humors. Yet, they also emphasized how environmental disturbances led to excesses or
deficiencies of these physical fluids. Similarly, since the 17th century observers have associated
the pressures of civilization, stressful lifestyles, domestic woes, and unhealthy living conditions
with mental illness while simultaneously indicating that biologically and psychologically
vulnerable people are the most likely ones to succumb to these burdens. Likewise, although 19th-
century psychiatrists commonly viewed heredity as the chief source of insanity, they also
invoked triggering causes such as financial ruin, family troubles, or masturbation to explain who
among predisposed people actually developed some mental illness.63
Many current neuroscientists as well are beginning to focus on gene–environment
relationships rather than on isolated brain or genetic processes.64 Such interactive conceptions do
not view internal and external forces as competing explanations but seek to understand the ways
in which various kinds of social environments provoke or suppress biological predispositions.
Such explanations emphasize how the causes of mental disorder resist reduction to any single
factor, whether within or outside of individuals. Accounts and treatments featuring internal or
external dynamics or their combinations have waxed and waned throughout history.
A number of the questions that engage the modern mental health professions—what
constitutes a mental disorder; are mental disorders continuous with or discrete from normal
behaviors; do holistic cultural and personality factors or specific diseases underlie mental
symptoms; and how do biological and psychological liabilities interact with external stressors?—
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would be familiar to practitioners across the ages. Although the technologies available to mental
health specialists at present vastly exceed those available in prior periods, it is an open question
whether extant definitions of, explanations for, and responses to mental disorders surpass those
of preceding eras.

Plan of the Book

The chapters that follow examine the answers that have arisen in various historical periods about
the nature of mental illness, the degree to which it resembles or is distinct from bodily diseases,
what type of experts have the legitimate authority to treat it, and which factors cause and might
cure it. The following chapter considers how these questions were formulated and answered in
the West before the psychiatric profession was established in the 19th century. It begins by
describing three distinct views that developed among the ancient Greeks: the Homeric, Platonic,
and Hippocratic conceptions that developed external, mental, and organic views of madness,
respectively. During the long period between the fall of Rome and the 17th century, faith-based
outlooks supplanted organic views and medicine became subordinate to the church. The
subsequent European Enlightenment resulted in two distinct biological and psychological
conceptions of mental disorders. At the same time, definitions of mental illness expanded to
encompass nervous conditions that had little resemblance to traditional stereotypes of madness.
Chapter 3 considers the model of mental disorder that arose in the 19th century alongside the
creation of a new profession dedicated to the treatment of mental illness. This period marked the
advent of psychiatrists as the socially legitimate arbiters of what constituted sanity and madness.
Their conceptions embraced biomedical tenets that grounded mental disorders in defective
brains, viewed mental illnesses as comparable to physical illnesses, and focused on inner,
organic causes. Nevertheless, most believed that madness usually arose in conjunction with some
socially based triggering event. A new type of response to the insane—inpatient mental asylums
—also became widespread during this era.
The fourth chapter discusses Sigmund Freud’s revolutionary model of mental illness that he
developed at the beginning of the 20th century. Upending previous conceptions, Freud’s
psychodynamic approach emphasized the similarities of normal and neurotic behaviors, the
differences between mental and physical symptoms, and the conflict between inner instincts and
social forces of repression as the major generator of both healthy and pathological expressions.
The dynamic model, which became especially influential in the United States, expanded the
realm of psychiatry to outpatient practices, the control of deviance, and understandings of
everyday life. It was far less influential in affecting the treatment of psychotic forms of madness,
which it generally ignored.
While the previous three chapters primarily concern European developments, the remaining
chapters focus on the United States. Chapter 5 examines how American dynamic psychiatry
evolved into a more environmental approach after World War II. In collaboration with the
military and the National Institute of Mental Health, a new socially oriented psychiatry applied
therapeutic frameworks to a wide array of distressing conditions and strove to prevent, as well as
treat, mental disorders. Its psychosocial model embraced expansive definitions of what
constituted mental illness, separated mental from physical conditions, and focused on external
rather than interior causes of psychic disturbances. During this era, psychiatric influence gained
unprecedented scope and reach.
The next chapter examines the crisis that arose in American psychiatry during the 1960s and
deepened in the 1970s. An anti-psychiatry movement developed that denied the very existence of
mental disorders. An influential counterculture emerged that regarded psychiatry as upholding
outmoded and oppressive social norms. At the same time, non-medical mental health
professionals challenged psychiatry’s dominion over psychotherapy. Third party insurers that
paid for mental health treatment came to question the efficacy of dynamic therapies. Psychiatry’s
sponsors in the federal government also became skeptical of expansive programs of prevention
and social change. The field’s very existence came into peril in this period.
Chapter 7 describes how the appearance of the DSM-III in 1980 resolved psychiatry’s crisis of
legitimacy. This new diagnostic system used a biomedical model that equated mental with
physical disorders to reclassify all of the numerous conditions that had concerned dynamic
psychiatrists. But, in contrast to the psychodynamic model, diagnostic psychiatry sharply split
mental disorders from normal behaviors. At the same time, it was agnostic about the causes of
mental illnesses. The manual’s great accomplishment was to provide the specific diseases that
psychiatry required for it to seem to be a genuine medical specialty. The DSM-III allowed
psychiatry to reinvent itself as a scientifically grounded discipline, a portrayal that persists to the
present.
The following chapter surveys the rise of neuroscientific studies of mental illness that have
dominated research since the 1980s. Much like its 19th-century predecessors, this model regards
understanding the brain as the key to unlock the mysteries of mental illnesses. It combines the
DSM’s classifications with a militantly biological approach to explaining various conditions.
Neuroscientific findings, however, thoroughly conflict with the DSM model: they indicate that
mental illnesses reflect overlapping general vulnerabilities more than isolatable, specific
disorders, gradations rather than discrete entities, and a complicated array of inner and external
causes that interact with brain-based mechanisms.
The penultimate chapter examines the paradox of the enormous institutional, social, and
cultural successes of the DSM revolution with its inability to validly capture the nature of mental
disorder. It focuses on three consequences of the DSM nosology. First, epidemiological studies
produce vast, but useful, overestimates of the amount of mental disorder in the general
population. Second, the DSM system has produced a divide between clinicians who find the
extant system of great practical value and researchers who see it as hindering progress in
understanding the nature of mental disorders and in developing targeted treatments for them.
This led psychiatric researchers to attempt to replace the DSM’s categorical taxonomy with a
dimensional system in the DSM-5, published in 2013. Finally, the chapter discusses the DSM-5’s
elimination of the bereavement exclusion in the criteria for major depression and its implications
for psychiatric diagnosis.
The concluding chapter surveys the arc of answers observers have provided to questions about
the division between sanity and madness, the resemblances and distinctions of mental and
physical illnesses, and the causes of and treatments for mental illnesses. It considers the extent to
which current conceptions of mental disorders represent advances or, in some cases, regressions
compared to historical understandings. It ends by speculating about future possible developments
in responses to mental health and illness and in the psychiatric profession.
All societies have grappled with questions about the nature of mental illness, its
commonalities with and differences from physical illness, and the forces that cause and might
overcome it. Examining the changing answers they have provided allows us to see the extent to
which current explanations surpass or are equivalent to—or in some cases, are even deficient
compared to—prior understandings.
 Notes
1. Murphy, 1972.
2. Cawte, 1974, 56–57.
3. Jaspers, 1946, quoted in Shorter, 2015, 122.
4. Kessler et al., 2003a; https://www.nimh.nih.gov/health/statistics/mental-illness.shtml.
5. Moffitt et al., 2010.
6. Rohde et al., 2013.
7. World Health Organization, 2001, 37.
8. E.g. Rosen, 1968; Porter, 1997.
9. Rosen, 1968, 67.
10. Goffman, 1971, 356.
11. Edgerton, 1969, 59.
12. American Psychiatric Association (APA), 2013, 20.
13. Wakefield, 1992 1999. See also Klein, 1999.
14. Jackson, 1986, 45.
15. Griesinger, 2000, 226.
16. https://www.additudemag.com/michael-phelps-adhd-advice-from-the-olympians-mom/.
17. Wakefield, 1999.
18. Layton et al., 2018. Phelps was born on June 30; he would have been about ten months younger than the
oldest students in his class.
19. APA, 2013, 697–700.
20. Spitzer & Wakefield, 2002.
21. Grant, 1978, 32.
22. Green, 2002, 467.
23. See especially Cosmides & Tooby, 1999.
24. Kendell, 1986, 25.
25. The distress or disability requirement emerged out of the controversy, recounted in Chapter 6 of this
volume, over whether homosexuality should be seen as a mental disorder. The outcome was to eliminate
homosexuality from the diagnostic manual unless it was “regularly accompanied by subjective distress
and/or ‘some generalized impairment in social effectiveness of functioning’ ” (Bayer, 1981, 127). This
solution was illogical because if homosexuality was not a dysfunction, it could not be a mental disorder
regardless of the degree of disability or disability it entailed. Later psychiatric manuals completely excised
this condition from consideration as a mental disorder.
26. E.g. Wakefield, 1992; 2006.
27. It is, of course, possible that people who deny they have a serious mental illness are correct.
28. Jamison, 1993.
29. Benedict, 1934, 60.
30. Benedict, 1934, 79.
31. In fact, Benedict’s own work indicates that at least some of the shamans she described had seriously
impairing dysfunctions. She notes that Siberian shamans could be “violently insane for several years, others
irresponsible to the point where they have to be watched constantly lest they wander off in the snow and
freeze to death, others ill and emaciated to the point of death, sometimes with bloody sweat” (Benedict,
1934, 62).
32. Garbowsky, 1989.
33. Ego-dystonic homosexuality appeared in the DSM-III in 1980 but was removed from the next edition of the
DSM in 1986.
34. Although the DSM uses the statistical term “expectable” to distinguish appropriate from disordered
conditions, “explicable” seems to more accurately convey the intended meaning. See Busfield, 2011, 155.
35. Kleinman, 2012, 608.
36. Kleinman, 2012, 608.
37. Kendler, 2008.
38. Wakefield & First, 2013.
39. APA, 2013, 271–72.
40. Edgerton, 1966, 419, italics in original.
41. https://www.upi.com/FBI-docs-reveal-Sandy-Hook-shooters-interest-in-mass-murder/4481508889851/.
42. https://www.vanityfair.com/news/2014/03/peter-lanza-adams-father-newtown-shooting.
43. APA, 2013, 248.
44. Alan Gregg, quoted in Whooley, 2019, 120.
45. Sadler, 2013a, 455.
46. E.g. Wakefield, Kirk, & Pottick, 2006.
47. Ghaemi, 2013, 811.
48. Horwitz, 1982; Wakefield, 1999, 379.
49. The DSM-5 criteria for adjustment disorder provide a notable exception. This condition arises after a
stressor and terminates within six months of the stressor, virtually the definition of a contextually
appropriate response (APA, 2013, 286–87).
50. Wakefield, 1999.
51. Freidson, 1970, 208.
52. Quoted in Porter, 2002, 37.
53. U.S. Department of Health and Human Services, 1999.
54. Rosenberg, 2007, 13.
55. APA, 1994, xxi. Similarly, mental health advocacy groups encourage the use of language such as “a person
with schizophrenia” instead of “a schizophrenic” to separate disorders from the individuals who have them.
E.g. https://www.ncbi.nlm.nih.gov/books/NBK333029/.
56. Quoted in Shorter, 1992, 181.
57. Kraepelin, 1919.
58. Szasz, 1961.
59. Quoted in Scull, 2015, 171.
60. Churchland, 1984, 145.
61. E.g. Freud, 1900/1965, 1905/1962.
62. E.g. Beck, 1967, 1991.
63. See especially Porter, 2018.
64. E.g. Conley & Fletcher, 2018.
 2
Before Psychiatry

Medicine is a science which hath been more professed than labored, and yet more labored than
advanced; the labour having been, in my judgment, rather in circle than in progression. For I find
much iteration, but small addition.
—Francis Bacon, The Advancement of Learning (1605)

A dedicated profession of psychiatry did not emerge until the late 18th century in Europe and the
mid-19th century in the United States. Nevertheless, before that time all groups confronted
questions about how to define mental illness, which authority had jurisdiction over the mad, what
caused madness, and the best ways to treat it. Their answers show both divergences from and
similarities to more recent conceptions.

Sanity and Madness in Ancient Greece

The Greeks produced most of the extant written sources regarding views of mental disorder in
the ancient world. Their earliest literary works from about 800 to 700 BCE, the Iliad and the
Odyssey, portray many characters who are driven mad through supernatural interventions. Greek
physicians during the Classical period in the 5th and 4th centuries BCE produced the first
sustained medical discussions about sanity and madness.1 Hippocratic medicine rooted mental
illnesses in the physical composition of brains and bodily fluids, developing sophisticated
theories about mental disturbance that persist in various guises to the present. During the same
era, Platonist philosophers, in certain ways foreshadowing Freud’s theories, viewed madness as
reflecting some inner psychic conflict or weakness. The widely varying external, organic, and
psychological theories of mental illness that the Greeks developed, as channeled through Galenic
medical culture in Rome, provided the major templates for thought about mental illness for the
following two millennia. Indeed, a “substantial unity” still exists between ancient and modern
views of mental disorder.2

Distinguishing Madness from Sanity

For the Greeks, mental illness referred to behaviors that clearly fell outside the boundaries of
sanity and so were “mad,” “crazy,” or “lunatic.” Socrates (c. 470–399 BCE) summarized this view
when he stated that people
Do not call those mad who err in matters that lie outside the knowledge of ordinary people: madness is the
name they give to errors in matters of common knowledge. For instance if man imagines himself to be so tall
as to stoop when he goes through the gateways in the Wall, or so strong as to try to lift houses or to perform
any other feat that everybody knows to be impossible, they say he’s mad. They don’t think a slight error
implies madness, but just as they call a strong desire love, so they name a great delusion madness.3
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experiments as interference-band production, in which a distortion
equal to one wave-length of light would be fatal. In all such cases of
ideal deposition, those interfacial angles on the crystal which the
particular symmetry developed requires to be equal actually are so,
to this same high degree of refinement. This fact renders possible
exceedingly accurate crystal measurement, that is, the determination
of the angles of inclination of the faces to each other, provided
refined measuring instruments (goniometers), pure chemical
substances, and the means of avoiding disturbance, either material
or thermal, during the deposition of the crystal, are available.
The study of crystals naturally divides itself into two more or less
distinct but mutually very helpful branches, and equally intimately
connected with the internal structure of crystals, namely, one which
concerns their exterior configuration and the structural morphology
of which it is the eloquent visible expression, and another which
relates to their optical characters. For the latter are so definitely
different for the different systems of crystal symmetry that they
afford the greatest possible help in determining the former, and give
the casting vote in all cases of doubt left after the morphological
investigation with the goniometer. It is, of course, their brilliant
reflection and refraction of light, with production of numerous
scintillations of reflected white light and of refracted coloured
spectra, which endows the hard and transparent mineral crystals,
known from time immemorial as gem-stones, with their attractive
beauty. Indeed, their outer natural faces are frequently, and
unfortunately usually, cut away most sacrilegiously by the lapidary,
in order that by grinding and polishing on them still more numerous
and evenly distributed facets he may increase to the maximum the
magnificent play of coloured light with which they sparkle.
An interesting and very beautiful lecture experiment was
performed by the author in a lecture a few years ago at the Royal
Institution, which illustrated in a striking manner this fact that the
light reaching the eye from a crystal is of two kinds, namely, white
light reflected from the exterior faces and coloured light which has
penetrated the crystal substance and emerges refracted and
dispersed as spectra. Two powerful beams of light from a pair of
widely separated electric lanterns were concentrated on a cluster of
magnificent large diamonds, kindly lent for the purpose by Mr Edwin
Streeter, and arranged in the shape of a crown, it being about the
time of the Coronation of His late Majesty King Edward VII. The
effect was not only to produce a blaze of colour about the diamonds
themselves, but also to project upon the ceiling of the lecture theatre
numerous images in white light of the poles of the electric arc,
derived by reflection from the facets, interspersed with equally
numerous coloured spectra derived from rays which had penetrated
the substance of the diamonds, and had suffered both refraction and
internal reflection.
 CHAPTER II
THE MASKING OF SIMILARITY OF SYMMETRY AND CONSTANCY OF
ANGLE BY DIFFERENCE OF HABIT, AND ITS INFLUENCE ON EARLY
STUDIES OF CRYSTALS.

Fig. 5.—Natural Rhombohedron of

Iceland Spar with Subsidiary Faces.

Nothing is more remarkable than the great variety of geometrical

shapes which the crystals of the same substance, derived from
different localities or produced under different conditions, are
observed to display. One of the commonest of minerals, calcite,
carbonate of lime, shows this feature admirably; the beautiful large
rhombohedra from Iceland, illustrated in Fig. 5, or the hexagonal
prisms capped by low rhombohedra from the Bigrigg mine at
Egremont in Cumberland, shown in Fig. 6, appear totally different
from the “dog-tooth spar” so plentifully found all over the world, a
specimen of which from the same mine is illustrated in Fig. 7. No
mineral specimens could well appear more dissimilar than these
represented on Plate III. in Figs. 6 and 7, when seen side by side in
the mineral gallery of the British Museum (Natural History) at South
Kensington. But all are composed of similar chemical molecules of
calcium carbonate, CaCO3; and when the three kinds of crystals are
investigated they are found to be identical in their crystalline system,
the trigonal, and indeed further as to the subdivision or class of that
system, which has come to be called the calcite class from the
importance of this mineral.

PLATE III.

Fig. 6.—Hexagonal Prisms of Calcite terminated by

Rhombohedra.
 Fig. 7.—Scalenohedral Crystals of Calcite, “Dog-tooth Spar.”

Crystals of Calcite from the same Mine, illustrating

Diversity of Habit.

(Photographed from Specimens in the Natural History

Department of the British Museum, by kind permission.)

Moreover, many of the same faces, that is, faces having the same
relation to the symmetry, are present on all three varieties, the
“forms” to which they equally belong being the common heritage of
calcite wherever found. A “form” is the technical term for a set of
faces having an equal value with respect to the symmetry. Thus the
prismatic form in Fig. 6 is the hexagonal prism, a form which is
common to the hexagonal and trigonal systems of symmetry, and the
form “indices” (numbers[1] inversely proportional to the intercepts
cut off from the crystal axes by the face typifying the form) of which
are {2̄1̄1}; the large development of this form confers the elongated
prismatic habit on the crystal. The terminations are faces of the flat
rhombohedron {110}. The pyramidal form of the dog-tooth spar
shown in Fig. 7 is the scalenohedron {20̄1}, and it is this form which
confers the tooth-like habit, so different from the hexagonal prism,
upon this variety of calcite. But many specimens of dog-tooth spar,
notably those from Derbyshire, consist of scalenohedra the middle
portion of which is replaced by faces of the hexagonal prism {2̄1̄1},
and the terminations of which are replaced by the characteristic
rhombohedron {100} of Iceland spar; indeed, it is quite common to
find crystals of calcite exhibiting on the same individual all the forms
which have been mentioned, that is, those dominating the three very
differently appearing types. The author has quite recently measured
such a crystal, which, besides showing all these four forms well
developed, also exhibited the faces of two others of the well-known
forms of calcite, {3̄1̄1} and {310}, and a reproduction of a drawing of
it to scale is given in Fig. 8. Instead of indices the faces of each form
bear a distinctive letter; m = {2̄1̄1}, r = {100}, e = {110}, v = {20̄1}
(the faces of the scalenohedron are of somewhat small dimensions on
this crystal), n = {3̄1̄1}, and t = {310}.
It is obviously then the “habit” which is
different in the three types of calcite—Iceland
spar, prismatic calc-spar, and dog-tooth spar
—doubtless owing to the different local
circumstances of growth of the mineral. Habit
is simply the expression of the fact that a
specific “form,” or possibly two particular
forms, is or are much more prominently
developed in one variety than in another.
Thus the principal rhombohedron r = {100},
parallel to the faces of which calcite cleaves so
readily, is the predominating form in Iceland
spar, while the scalenohedron v = {20̄1} is the
habit-conferring form in dog-tooth spar. Yet
on the latter the rhombohedral faces are
Fig. 8.—Measured frequently developed, blunting the sharp
Crystal of Calcite. terminations of the scalenohedra, especially
in dog-tooth spar from Derbyshire or the
Hartz mountains; and on the former minute
faces of the scalenohedron are often found, provided the
rhombohedron consists of the natural exterior faces of the crystal
and not of cleavage faces. In the same manner the prismatic crystals
from Egremont are characterised by two forms, the hexagonal prism
m = {2̄1̄1} and the secondary rhombohedron e = {110}, but both of
these forms, as we have seen on the actual crystal represented in Fig.
8, are also found developed on other crystals of mixed habit.
 This illustration from the naturally occurring minerals might
readily be supplemented by almost any common artificial chemical
preparation, sulphate of potash for instance, K2SO4, the
orthorhombic crystals of which take the form of elongated prisms,
even needles, on the one hand, or of tabular plate-like crystals on the
other hand, according as the salt crystallises by the cooling of a
supersaturated solution, or by the slow evaporation of a solution
which at first is not quite saturated. In both cases, and in all such
cases, whether of minerals or chemical preparations, the same planes
are present on the crystals of the same substance, although all may
not be developed on the same individual except in a few cases of
crystals particularly rich in faces; and these same planes are inclined
at the same angles. But their relative development may be so very
unlike on different crystals as to confer habits so very dissimilar that
the fact of the identity of the substance is entirely concealed.
A further example may perhaps be given,
that of a substance, hydrated sulphate of lime,
CaSO4.2H2O, which occurs in nature as the
beautiful transparent mineral gypsum or
selenite—illustrated in Fig. 9, and which is
found in monoclinic crystals often of very
large size—and which may also be chemically
prepared by adding a dilute solution of
sulphuric acid to a very dilute solution of
calcium chloride. The radiating groups of
needles shown in Fig. 10 (Plate II.) slowly
crystallise out when a drop of the mixed
solution is placed on a microscope slip and
examined under the microscope, using the
one-inch objective. These needles, so
absolutely different in appearance from a
crystal of selenite, are yet similar monoclinic
prisms, but in which the prismatic form is
enormously elongated compared with the
other (terminating) form. Fig. 9.—Crystal of
Gypsum.
This difference of facial development,
rendering the crystals of one and the same
substance from different sources so very unlike each other, was
apparently responsible for the very tardy discovery of the
fundamental law of crystallography, the constancy of the crystal
angles of the same substance. Gessner, sometime between the years
1560 and 1568, went so far as to assert that not only are different
crystals of the same substance of different sizes, but that also the
mutual inclinations of their faces and their whole external form are
dissimilar.
What was much more obvious to the early students of crystals, and
which is, in fact, the most striking thing about a crystal after its
regular geometric exterior shape, was the obviously homogeneous
character of its internal structure. So many crystals are transparent,
and so clear and limpid, that it was evident to the earliest observers
that they were at least as homogeneous throughout as glass, and yet
that at the same time they must be endowed with an internal
structure the nature of which is the cause of both the exterior
geometric regularity of form, so different from the irregular shape of
a lump of glass, and of the peculiar effect on the rays of light which
are transmitted through them. From the earliest ages of former
civilisations the behaviour of crystals with regard to light has been
known to be different for the different varieties of gem-stones.
About the year 1600 Cæsalpinus observed that sugar, saltpetre,
and alum, and also the sulphates of copper, zinc and iron, known
then as blue, white and green vitriol respectively, separate from their
solutions in characteristic forms. Had he not attributed this to the
operation of an organic force, in conformity with the curious opinion
of the times concerning crystals, he might have had the credit of
being the pioneer of crystallographers. The first two real steps in
crystallography, however, with which in our own historic times we
are acquainted, were taken in the seventeenth century within four
years of each other, one from the interior structural and the other
from the exterior geometrical point of view. For in 1665 Robert
Hooke in this country made a study of alum, which he appears to
have obtained in good crystals, although he was unacquainted with
its true chemical composition. He describes in his “Micrographia”
how he was able to imitate the varying habits of the octahedral forms
of alum crystals by building piles of spherical musket bullets, and
states that all the various figures which he observed in the many
crystals which he examined could be produced from two or three
arrangements of globular particles. It is clear that the homogeneous
partitioning of space in a crystal structure by similar particles
building up the crystal substance was in Hooke’s mind, affording
another testimony to the remarkably prescient insight of our great
countryman.
Four years later, in 1669, Nicolaus Steno carried out in Florence
some remarkable measurements, considering the absence of proper
instruments, of the angles between the corresponding faces of
different specimens of rock-crystal (quartz, the naturally occurring
dioxide of silicon, concerning which there will be much to say later in
this book), obtained from different localities, and published a
dissertation announcing that he found these analogous angles all
precisely the same.
In the year 1688 the subject was taken up systematically by
Guglielmini, and in two memoirs of this date and 1705 he extended
Steno’s conclusions as to the constancy of crystal angles in the case of
rock-crystal into a general law of nature. Moreover, he began to
speculate about the interior structure of crystals, and, like Hooke, he
took alum as his text, and suggested that the ultimate particles
possessed plane faces, and were, in short, miniature crystals. He
further announced the constancy of the cleavage directions, so that
to Guglielmini must be awarded the credit for having, at a time when
experimental methods of crystallographic investigation were
practically nil, discovered the fundamental principles of
crystallography.
The fact that a perfect cleavage is exhibited by calcite had already
been observed by Erasmus Bartolinus in 1670, and in his
“Experimenta Crystalli Islandici” he gives a most interesting account
of the great discovery of immense clear crystals of calcite which had
just been made at Eskifjördhr in Iceland, minutely describing both
their cleavage and their strong double refraction. Huyghens in 1690
followed this up by investigating some of these crystals of calcite still
more closely, and elaborated his laws of double refraction as the
result of his studies.
There now followed a century which was scarcely productive of any
further advance at all in our real knowledge of crystals. It is true that
Boyle in 1691 showed that the rapidity with which a solution cools
influences the habit of the crystals which are deposited from it. But
neither Boyle, with all his well-known ability, so strikingly displayed
in his work on the connection between the volume of a gas and the
pressure to which it is subjected, nor his lesser contemporaries
Lemery and Homberg, who produced and studied the crystals of
several series of salts of the same base with different acids,
appreciated the truth of the great fact discovered by Guglielmini, that
the same substance always possesses the same crystalline form the
angles of which are constant. Even with the growth of chemistry in
the eighteenth century, the opinion remained quite general that the
crystals of the same substance differ in the magnitude of their angles
as well as in the size of their faces.
We begin to perceive signs of progress again in the year 1767, when
Westfeld made the interesting suggestion that calcite is built up of
rhombohedral particles, the miniature faces of which correspond to
the cleavage directions. This was followed in 1780 by a treatise “De
formis crystallorum” by Bergmann and Gahn of Upsala, in which
Guglielmini’s law of the constancy of the cleavage directions was
reasserted as a general one, and intimately connected with the
crystal structure. It was in this year 1780 that the contact goniometer
was invented by Carangeot, assistant to Romé de l’Isle in Paris, and it
at once placed at the disposal of his master a weapon of research far
superior to any possessed by previous observers.
 Fig. 11.—Contact Goniometer as used by Romé de l’Isle.

In his “Crystallographie,” published in Paris in 1783, Romé de

l’Isle described a very large number of naturally occurring mineral
crystals, and after measuring their angles with Carangeot’s
goniometer he constructed models of no less than 500 different
forms. Here we have work based upon sound measurement, and
consequently of an altogether different and higher value than that
which had gone before. It was the knowledge that his master desired
to faithfully reproduce the small natural crystals which he was
investigating, on the larger scale of a model, that led Carangeot to
invent the contact goniometer, and thus to make the first start in the
great subject of goniometry. The principle of the contact goniometer
remains to-day practically as Carangeot left it, and although replaced
for refined work by the reflecting goniometer, it is still useful when
large mineral crystals have to be dealt with. An illustration of a
duplicate of the original instrument is shown in Fig. 11, by the
kindness of Dr H. A. Miers. This duplicate was presented to Prof.
Buckland by the Duke of Buckingham in the year 1824, and is now in
the Oxford Museum.
From the time that measurement of an accurate description was
possible by means of the contact goniometer, progress in
crystallography became rapid. Romé de l’Isle laid down the sound
principle, as the result of the angular measurements and the
comparison of his accurate models with one another, that the various
crystal shapes developed by the same substance, artificial or natural,
were all intimately related, and derivable from a primitive form,
characteristic of the substance. He considered that the great variety
of form was due to the development of secondary faces, other than
those of the primitive form. He thus connected together the work of
previous observers, consolidated the principles laid down by
Guglielmini by measurements of real value, and threw out the
additional suggestion of a fundamental or primitive form.
About the same time Werner was studying the principal forms of
different crystals of the same substance. The idea of a fundamental
form appears to have struck him also, and he showed how such a
fundamental form may be modified by truncating, bevelling, and
replacing its faces by other derived forms. His work, however, cannot
possess the value of that of Romé de l’Isle, as it was not based on
exact measurement, and most of all because Werner appears to have
again admitted the fallacy that the same substance could, in the
ordinary way, and not in the sense now termed polymorphism,
exhibit several different fundamental forms.
But a master mind was at hand destined definitely to remove these
doubts and to place the new science on a firm basis. An account of
how this was achieved is well worthy of a separate chapter.
 CHAPTER III
THE PRESCIENT WORK OF THE ABBÉ HAÜY.

The important work of Romé de l’Isle had paved the way for a
further and still greater advance which we owe to the University of
Paris, for its Professor of the Humanities, the Abbé Réné Just Haüy,
a name ever to be regarded with veneration by crystallographers,
took up the subject shortly after Romé de l’Isle, and in 1782 laid most
important results before the French Academy, which were
subsequently, in 1784, published in a book, under the auspices of the
Academy, entitled “Essai d’une Théorie sur la Structure des
Crystaux.” The author happens to possess, as the gift of a kind friend,
a copy of the original issue of this highly interesting and now very
rare work. It contains a brief preface, dated the 26th November 1783,
signed by the Marquis de Condorcet, perpetual secretary to the
Academy (who, in 1794, fell a victim to the French revolution), to the
effect that the Academy had expressed its approval and authorised
the publication “under its privilege.”
The volume contains six excellent plates of a large number of most
careful drawings of crystals, illustrating the derivation from the
simple forms, such as the cube, octahedron, dodecahedron,
rhombohedron, and hexagonal prism, of the more complicated forms
by the symmetrical replacement of edges and corners, together with
the drawings of many structural lattices. In the text, Haüy shows
clearly how all the varieties of crystal forms are constructed
according to a few simple types of symmetry; for instance, that the
cube, octahedron, and dodecahedron all have the same high degree
of symmetry, and that the apparently very diverse forms shown by
one and the same substance are all referable to one of these simple
fundamental or systematic forms. Moreover, Haüy clearly states the
laws which govern crystal symmetry, and practically gives us the
main lines of symmetry of five of the seven systems as we now
classify them, the finishing touch having been supplied in our own
time by Victor von Lang.
Haüy further showed that difference of chemical composition was
accompanied by real difference of crystalline form, and he entered
deeply into chemistry, so far as it was then understood, in order to
extend the scope of his observations. It must be remembered that it
was only nine years before, in 1774, that Priestley had discovered
oxygen, and that Lavoisier had only just (in the same year as Haüy’s
paper was read to the Academy, 1782) published his celebrated
“Elements de Chimie”; and further, that Lavoisier’s memoir
“Reflexions sur le Phlogistique” was actually published by the
Academy in the same year, 1783, as that in which this book was
written by Haüy. Moreover, it was also in this same year, 1783, that
Cavendish discovered the compound nature of water.
Considering, therefore, all these facts, it is truly surprising that
Haüy should have been able to have laid so accurately the
foundations of the science of crystallography. That he undoubtedly
did so, thus securing to himself for all time the term which is
currently applied to him of “father of crystallography,” is clearly
apparent from a perusal of his book and of his subsequent memoirs.
The above only represents a small portion of Haüy’s achievements.
For he discovered, besides, the law of rational indices, the
generalisation which is at the root of crystallographic science,
limiting, as it does, the otherwise infinite number of possible crystal
forms to comparatively few, which alone are found to be capable of
existence as actual crystals. The essence of this law, which will be
fully explained in Chapter V., is that the relative lengths intercepted
along the three principal axes of the crystal, by the various faces
other than those of the fundamental form, the faces of which are
parallel to the axes, are expressed by the simplest unit integers, 1, 2,
3, or 4, the latter being rarely exceeded and then only corresponding
to very small and altogether secondary faces.
This discovery impressed Haüy with the immense influence which
the structure of the crystal substance exerts on the external form,
and how, in fact, it determines that form. For the observations were
only to be explained on the supposition that the crystal was built up
of structural units, which he imagined to be miniature crystals
shaped like the fundamental form, and that the faces were dependent
on the step-like arrangement possible to the exterior of such an
assemblage. This brought him inevitably to the intimate relation
which cleavage must bear to such a structure, that it really
determined the shape of, and was the expression of the nature of, the
structural units. Thus, before the conception of the atomic theory by
Dalton, whose first paper (read 23rd October 1803), was published
in the year 1803 in the Proceedings of the Manchester Literary and
Philosophical Society, two years after the publication of Haüy’s last
work (his “Traité de Minéralogie,” Paris, 1801), Haüy came to the
conclusion that crystals were composed of units which he termed
“Molécules Intégrantes,” each of which comprised the whole
chemical compound, a sort of gross chemical molecule. Moreover, he
went still further in his truly original insight, for he actually
suggested that the molécules intégrantes were in turn composed of
“Molécules Elémentaires,” representing the simple matter of the
elementary substances composing the compound, and hinted further
that these elementary portions had properly orientated positions
within the molécules intégrantes.
He thus not only nearly forestalled Dalton’s atomic theory, but also
our recent work on the stereometric orientation of the atoms in the
molecule in a crystal structure. Dalton’s full theory was not published
until the year 1811, in his epoch-making book entitled “A New
System of Chemical Philosophy,” although his first table of atomic
weights was given as an appendix to the memoir of 1803. Thus in the
days when chemistry was in the making at the hands of Priestley,
Lavoisier, Cavendish, and Dalton do we find that crystallography was
so intimately connected with it that a crystallographer well-nigh
forestalled a chemist in the first real epoch-making advance, a lesson
that the two subjects should never be separated in their study, for if
either the chemist or the crystallographer knows but little of what the
other is doing, his work cannot possibly have the full value with
which it would otherwise be endowed.
The basis of Haüy’s conceptions was undoubtedly cleavage. He
describes most graphically on page 10 of his “Essai” of 1784 how he
was led to make the striking observation that a hexagonal prism of
calcite, terminated by a pair of hexagons normal to the prism axis,
similar to the prisms shown in Fig. 6 (Plate III.) except that the ends
were flat, showed oblique internal cleavage cracks, by enhancing
which with the aid of a few judicious blows he was able to separate
from the middle of the prism a kernel in the shape of a
rhombohedron, the now well-known cleavage rhombohedron of
calcite. He then tried what kinds of kernels he could get from dog-
tooth spar (illustrated in Fig. 7) and other different forms of calcite,
and he was surprised to find that they all yielded the same
rhombohedral kernel. He subsequently investigated the cleavage
kernels of other minerals, particularly of gypsum, fluorspar, topaz,
and garnet, and found that each mineral yielded its own particular
kernel. He next imagined the kernels to become smaller and smaller,
until the particles thus obtained by cleaving the mineral along its
cleavage directions ad infinitum were the smallest possible. These
miniature kernels having the full composition of the mineral he
terms “Molécules Constituantes” in the 1784 “Essai,” but in the 1801
“Traité” he calls them “Molécules Intégrantes” as above mentioned.
He soon found that there were three distinct types of molécules
intégrantes, tetrahedra, triangular prisms, and parallelepipeda, and
these he considered to be the crystallographic structural units.
Having thus settled what were the units of
the crystal structure, Haüy adopted Romé de
l’Isle’s idea of a primitive form, not
necessarily identical with the molécule
intégrante, but in general a parallelepipedon
formed by an association of a few molécules
Fig. 12. intégrantes, the parallelepipedal group being
termed a “Molécule Soustractive.” The
primary faces of the crystal he then supposed
to be produced by the simple regular growth or piling on of
molécules intégrantes or soustractives on the primitive form. The
secondary faces not parallel to the cleavage planes next attracted his
attention, and these, after prolonged study, he explained by
supposing that the growth upon the primitive form eventually ceased
to be complete at the edges of the primary faces, and that such
cessation occurred in a regular step by step manner, by the
suppression of either one, two, or sometimes three molécules
intégrantes or soustractives along the edge of each layer, like a
stepped pyramid, the inclination of which depends on how many
bricks or stone blocks are intermitted in each layer of brickwork or
masonry. Fig. 12 will render this quite clear, the face AB being
formed by single block-steps, and the face CD by two blocks being
intermitted to form each step. The plane AB or CD containing the
outcropping edges of the steps would thus be the secondary plane
face of the crystal, and the molécules intégrantes or soustractives
(the steps can only be formed by parallelepipedal units) being
infinitesimally small, the re-entrant angles of the steps would be
invisible and the really furrowed surface appear as a plane one. Haüy
is careful to point out, however, that the crystallising force which
causes this stepped development (or lack of development) is
operative from the first, for the minutest crystals show secondary
faces, and often better than the larger crystals.
An instance of a mineral with tetrahedral
molécules intégrantes Haüy gives in
tourmaline, and the primitive form of
tourmaline he considered to be a
rhombohedron, conformably to the well-
known rhombohedral cleavage of the mineral,
made up of six tetrahedra. Again, hexagonal
structures formed by three prismatic cleavage
planes inclined at 60° are considered by him Fig. 13.
as being composed of molécules intégrantes
of the form of 60° triangular prisms, or
molécules soustractives of the shape of 120° rhombic prisms, each of
the latter being formed by two molécules intégrantes situated base to
base. This will be clear from Figs. 13 and 14, the former representing
the structure as made up of equilateral prismatic structural units,
and the latter portraying the same structure but composed of 120°-
parallelepipeda by elimination of one cleavage direction; each unit in
the latter case possesses double the volume of the triangular one, and
being of parallelepipedal section is capable of producing secondary
faces when arranged step-wise, whereas the triangular structure is
not. The points at the intersections in these diagrams should for the
present be disregarded; they will shortly be referred to for another
purpose.
Probably, the most permanent and important of Haüy’s
achievements was the discovery of the law of rational indices. At first
this only took the form of the observation of the very limited number
 of rows of molécules intégrantes or
soustractives suppressed. In introducing it on
page 74 of his 1784 “Essai” he says: “Quoique
je n’aie observé jusqu’ici que des
décroissemens qui se sont par des
soutractions d’une ou de deux rangées de
molécules, et quelquefois de trois rangées,
mais très rarement, il est possible qu’il se
trouve des crystaux dans lesquels il y ait
Fig. 14.
quatre ou cinq rangées de molécules
supprimées à chaque décroissement, et même
un plus grand nombre encore. Mais ces cas me semblent devoir être
plus rares, à proportion que le nombre des rangées soutraites sera
plus considérable. On conçoit donc comment le nombre des formes
secondaires est néçessairement limité.”
The essential difference between Haüy’s views and our present
ones, which will be explained in Chapter IX., is that Haüy takes
cleavage absolutely as his guide, and considers the particles, into
which the ultimate operation of cleavage divides a crystal, as the
solid structural units of the crystal, the unit thus having the shape of
at least the molécule intégrante. Now every crystalline substance
does not develop cleavage, and others only develop it along a single
plane, or along a couple of planes parallel to the same direction, that
of their intersection and of the axis of the prism which two such
cleavages would produce, and which prism would be of unlimited
length, being unclosed.
Again, in other cases cleavage, such as the octahedral cleavage of
fluorspar, yields octahedral or tetrahedral molécules intégrantes
which are not congruent, that is to say, do not fit closely together to
fill space, as is the essence of Haüy’s theory. Hence, speaking
generally, partitioning by means of cleavage directions does not
essentially and invariably yield identical plane-faced molecules
which fit together in contact to completely fill space, although in the
particular instances chosen from familiar substances by Haüy it
often happens to do so. Haüy’s theory is thus not adequately general,
and the advance of our knowledge of crystal forms has rendered it
more and more apparent that Haüy’s theory was quite insufficient,
and his molécules intégrantes and soustractives mere geometrical
abstractions, having no actual basis in material fact; but that at the
same time it gave us a most valuable indication of where to look for
the true conception.
This will be developed further into our present theory of the
homogeneous partitioning of space, in Chapter IX. But it may be
stated here, in concluding our review of the pioneer work of Haüy,
that in the modern theory all consideration of the shape of the
ultimate structural units is abandoned as unnecessary and
misleading, and that each chemical molecule is considered to be
represented by a point, which may be either its centre of gravity, a
particular atom in the molecule (for we are now able in certain cases
to locate the orientation of the spheres of influence of the elementary
atoms in the chemical molecules), or a purely representative point
standing for the molecule. The only condition is that the points
chosen within the molecules shall be strictly analogous, and similarly
orientated. The dots at the intersections of the lines in Figs. 13 and 14
are the representative points in question. We then deal with the
distances between the points, the latter being regarded as molecular
centres, rather than with the dimensions of the cells themselves
regarded as solid entities. We thus avoid the as yet unsolved question
of how much is matter and how much is interspace in the room
between the molecular centres. In this form the theory is in
conformity with all the advances of modern physics, as well as of
chemistry. And with this reservation, and after modifying his theory
to this extent, one cannot but be struck with the wonderful
perspicacity of Haüy, for he appears to have observed and considered
almost every problem with which the crystallographer is confronted,
and his laws of symmetry and of rational indices are perfectly
applicable to the theory as thus modernised.
 CHAPTER IV
THE SEVEN STYLES OF CRYSTAL ARCHITECTURE.

It is truly curious how frequently the perfect number, seven, is

endowed with exceptional importance with regard to natural
phenomena. The seven orders of spectra, the seven notes of the
musical octave, and the seven chemical elements, together with the
seven vertical groups to which by their periodic repetition they give
rise, of the “period” of Mendeléeff’s classification of the elements,
will at once come to mind as cases in point. This proverbial
importance of the number seven is once again illustrated in regard to
the systems of symmetry or styles of architecture displayed by
crystals. For there are seven such systems of crystal symmetry, each
distinguished by its own specific elements of symmetry.
It is only within recent years that we have come to appreciate what
are the real elements of symmetry. For although there are but seven
systems, there are no less than thirty-two classes of crystals, and
these were formerly grouped under six systems, on lines which have
since proved to be purely arbitrary and not founded on any truly
scientific basis. It was supposed that those classes in any system
which did not exhibit all the faces possible to the system owed this
lack of development to the suppression of one-half or three-quarters
of the possible number, and such classes were consequently called
“hemihedral” and “tetartohedral” respectively. As in the higher
systems of symmetry there were usually two or more ways in which a
particular proportionate suppression of faces could occur, it
happened that several classes, and not merely three—holohedral
(possessing the full number of faces), hemihedral, and tetartohedral
—constituted each of these systems.
Thanks largely to the genius of Victor von Lang, who was formerly
with us in England at the Mineral Department of the British