The mad, like the poor and the appallingly rich, have always been with us. For despite the optimistic jingles of those enamoured of progress, societies of all kinds continue to accumulate all manner of casualties, citizens unkempt and curiously off-kilter. Whether democracy, monarchy or dictatorship, all manner of societies come ready made with those who cannot cope. They hide in dark corners, muttering; they run through the streets, shouting. They cower in fear, they lunge in contempt. They shriek and shiver, ecstatic and disconsolate by turns. The self-control exercised by others seems hopelessly unattainable for their tortured psyches, and we watch them sadly through society's blinkers, craving miraculous solutions to alleviate witness discomfort.

We seek such magic answers because we've tried everything else. Outright denial, bemused toleration, familial restraint, varieties of exorcism, the genteel country lodge, the horrific city asylum; regimens of exercise, gardening and general community uplift, or else sadistic incarceration, electroshock, lobotomies and drugs, drugs, drugs.

Roy Porter, an Englishman with a lifetime of experience in the field (sadly, he passed away very recently), surveyed the terrain, both known and undiscovered, and produced a short guide for the merely perplexed. Consolidating and summarising his earlier Mind-Forg'd Manacles and A Social History of Madness (from 1987 and æ88 respectively), he meant, and succeeded in, making this short work a permanent member of every well stocked reference shelf. As a professor of the social history of medicine, of University College in London, he was eminently suited to the job. And despite taking the easy way out by refusing even to try and fathom the true nature of mental disturbance, thus relieving himself of the unwieldy burden of taking a position, this compact (50,000) word essay on the history of madness and its treatments rounds up all the relevant stages in our evolving understanding of the lunatic's predicament and presents them with an ease which belies the convoluted disputes of the psychiatric profession. It is, as he claims in the books, a "brief, bold and unbiased account". Its clear and concise outline of the various trends and developments in identification, housing and treatment of those succumbing to such radical instabilities will facilitate the interested reader's quest for more detailed delineation in any of several directions.

The seeds of trend, theory and practice are all here, bubbling away in the historical stew. Take Thomas Szasz for example, who, since bursting upon the scene in 1961 with The Myth of Mental Illness, has repeatedly denied that there is such a thing as mental illness, arguing that it is not a disease "whose nature is being elucidated by science," and that it is a "myth, fabricated by psychiatrists for reasons of professional advancement and endorsed by society because it sanctions easy solutions for problem people." He alleged that medical men, over the centuries, "manufactured madness" by affixing labels to those who are "social pests, odd or challenging." He was soon joined by Michel Foucault, whose 1961 Madness and Civilisation argued that mental illness was not a "natural fact" but a "cultural construct", sustained by the self-interest of administrative and psychiatric practice. This softened the ground for the late sixties arrival of R.D. Laing, whose virulent "anti-psychiatry" stance sat very well with the then emergent counter culture, which took his society-itself-is-mad dictum quite to heart.

But this, of course, was the populist version. In the field itself, rebuttals were tardy, but thankfully not nearly so trendy. Porter quotes Roth and Krall's 1986 The Reality of Mental Illness, which effectively argues for the stability of psychiatric symptoms which are not "mere labels or scapegoating devices" and have "authentic organic bases." Needless to say, controversy continues to rage, both inside and out of the profession.

Madness, and the fiery debates over it are perhaps, as Porter succinctly observes "as old as mankind." We have 5000-year-old skulls with holes neatly drilled into them: we have Deuteronomy 6:5, "The Lord will smite thee with madness": elsewhere we have the Lord punishing Nebuchadnezzar by reducing him to "bestial madness": we have Medea slaying her children: and perhaps most famously, Euripedes: "Those whom the gods destroy they first make mad." Ancient days, it would seem, were choc-a-bloc with weeping, wailing and gnashing of teeth.

The Babylonians, Mesopotamians and early Greeks held to various forms of what we now think of as æsupernaturalism', spirit invasion and demonic malice. The individual, when they recognised him at all, was a weak vessel, shaken by passions and wild impulses, and ever open to possession. If the psychic civil war resulting from the usual hubris and ambition didn't get you, some badass dude with an attitude from hell would. Epilepsy was very definitely a "sacred disease", and was countered by much praying and sacrificing at the appropriate temple. And yet, even then, an unnamed follower of Hippocrates published a treatise "On The Sacred Disease" in which he lambasted the entire tradition, insisting that epilepsy was no more divine than any other creaturely malfunction, and that blaming Gods (Hera for convulsions and ægoat-like' behaviour, Ares for kicking and foaming at the mouth) was more in line with ignorance and the naivete of wonder than anything else.

A more recent foolishness that might be invoked in support of any number of witty formulations or comfy theories is George Beard's mid-19th century poularisation of the state he called æneurasthenia', an early brand of nervous breakdown suffered mainly by those who had the leisure to do so; it's draining of the individual's "nerve force" was brought on by the newly hectic pace of modern urban American lifeù"the telegraph, railroad and daily press" being cited as the main conspirators. "American nervousness is the product of American civilisation" he pronounced, perhaps unconsciously giving the nod to its future versions, fibromyalgia, chronic fatigue and their variously flushed environmental cousins. Whether any of these syndromes actually exist outside of the perceptions of the self-proclaimed sufferer and the weighty sanctions of his lurking professional is always open to debate, as is, unfortunately, practically every other explanatory hypothesis in this millennia-long clash of symptoms and convictions.

Let's examine Phrenology for example: developed by Gall and Spurzheim, this wanna-be science positing the brain as the only throne of the mind, persuaded its many adherents that the contours and configurations of the organ actually determined the profile of each personality under its care. A small orchestra of over thirty individual "organs" (expressing greed, pride, piety, etc.) was posited, each with its very own niche of bumps and squiggles to be prodded and mapped by its practitioners. Phrenology had, as we say, its day. And now that its day is long done, we can actually double over in glee without grasping that psychiatry itself may one day star in such a comedy. For as Porter quietly notes, despite its patent absurdities, phrenology was but one aspect of the growing "medical materialism" of the mid 18th century which served as useful ammo in the battles to limit psychiatric practise to the medically qualified and to initiate funding for the kind of laboratory research which was pioneered by, and then prospered in, Germany, allowing herr professor to pursue his theoretical and investigative passions rather than be lumbered with the bureaucratic and therapeutic schedules endured by his luckless English and American counterparts. One of them, Carl Westphal, shall forever live in the popular imagination as the originator of the knee-jerk reflex test immortalised in a thousand films and novels.

The "German somaticists", as they are called, were apparently really good at chopping up body bits under microscopes in attempts to explain the neurological mechanisms of perceived disorders. Whether any significant cures were effected seems, once again, open to endless discursive chatter, all of which winds up being beside the point, for there are, and always have been, a number of us who are profoundly bonkers, and who will, at the slightest provocation, leap out of windows and savage small children unless placed firmly out of harm's way. We have tarted up this brutal fact this way and that way until turning blue in the face, but the news just never seems to get any better.

Which brings me to the flood of tertiary syphilis victims into the late 1800s asylums, that seems to have bred a type of "therapeutic nihilism"ùarguing from a gloomy hereditary degenerationist model that entire families grow more and more hopeless, collapsing through the generations, from nervous hysteria, through booze and opium, prostitution and criminality, to plain insanity and, finally, "utter idiocy". Pushed by Maudsley in England and Morel in france, it apparently caught the fevered imaginations of post-1870 France, where "proletarian unrest and socialism" threatened to permanently upset the applecart. And speaking of degenerationism, let me not forget to mention Paul Mobius, whom Porter describes as a "particularly blatant misogynist" in a profession already saddled with more than its fair share of sexism, who had the unmitigated gall to publish, in 1900, "The Physiological Feeble Mindedness of Women". One wonders what a reincarnated Mobius would prattle on about today. ò