Historical perspectives

Scull (2015) notes that madness, its description, analysis and impact have been a source of fascination for artists, writers, film makers as well as academics and professionals from a range of disciplines. His magnificent work chronicles the way that madness and the treatment of the ‘mad’ has seemingly ebbed and flowed between periods of progress and others where treatments have lost any sense of human dignity. Scull shows that there seems to be no limit to the range of abuse that societies have been prepared to inflict on fellow citizens in the name of treatment of mental illness. Attitudes and understanding change over time. There is a danger that a focus on the present day assumes that these changes produce a linear progression. Outdated forms of management of the mentally ill are assumed to have been replaced by better systems based on recognition of the humanity of those who are suffering. This is problematic in two ways. It assumes we can easily make comparisons between approaches and historical epoch – for example asylum versus community care. This is a very reductionist approach that overlooks the complexity of the comparisons. It almost inevitably assumes that progress has been made. This is done without ever delineating what progress might actually mean or look like. It assumes that all moves are forward and we abandon oppressive attitudes, behaviours and forms of treatment as we go. Finally, such ahistorical approaches mean that we do not look at the failings within current systems in any real depth. One of the most important aspects of Foucault's (2006, 2008) work is that he forces us to rethink what we mean by progress or whether we can actually make comparisons at all. Is community care better than the asylum regime? If so, in what sense and how were these changes brought about? These are fundamental questions that are at the core of this work.

Language is, of course, vitally important and reflects the underlying views that societies have of those in particular groups. Mad, mentally ill, psychotic, schizophrenic, person living with dementia, service user, people with mental health problems: all these terms have been used and appear at some point in this book.