Diagnosing Madness

Book excerpt: An examination of the evolving rhetoric of psychiatric disease Diagnosing Madness is a study of the linguistic negotiations at the heart of mental illness identification and patient diagnosis. Through an examination of individual psychiatric case records from the late nineteenth and early twentieth centuries, Cristina Hanganu-Bresch and Carol Berkenkotter show how the work of psychiatry was navigated by patients, families, doctors, the general public, and the legal system. The results of examining those involved and their interactions show that the psychiatrist's task became one of constant persuasion, producing arguments surrounding diagnosis and asylum confinement that attempted to reconcile shifting definitions of disease and to respond to sociocultural pressures. By studying patient cases, the emerging literature of confinement, and patient accounts viewed alongside institutional records, the authors trace the evolving rhetoric of psychiatric disease, its impact on the treatment of patients, its implications for our contemporary understanding of mental illness, and the identity of the psychiatric patient. Diagnosing Madness helps elucidate the larger rhetorical forces that contributed to the eventual decline of the asylum and highlights the struggle for the professionalization of psychiatry.