by Lynn Gamwell and Nancy Tomes, Cornell University Press, 192 pages .

In 1865 a New York newspaper reported patients at New York City Lunatic Asylum “tripping the light fantastic toe” during a “lunatic ball,” a common activity in the more enlightened institutions of the nineteenth century. These surreal dancing parties were just one of many experiments in the uncertain, sometimes harrowing history of America’s treatment of mental illness that the authors of Madness in America , Lynn Gamwell and Nancy Tomes, have compiled in a grimly fascinating account. The early medical community, guided partly by the Enlightenment belief that a loss of reason equaled a loss of humanity, treated patients by subjecting them to physical abuse and displaying them in cages. Later on such harsh methods became rarer, but developing scientific theories were so riddled with social prejudices and halfformed ideas about evolution that they caused their own kinds of damage. An 1840 census, for example, found many insane blacks in the North but none in the South—clear evidence, pro-slavery advocates argued, that blacks could not function as free people. We gained the terms highbrow and lowbrow from the theory that base and unstable instincts “were apparent in [the] sloping forehead, or low brow” of non-Caucasians. Class biases thrived in asylums where the working classes labored while their wealthier counterparts were pampered, and gender biases were rampant, such as the theory that hysteria was an inherently female condition. Until ideas about the forces of the unconscious mind slowly emerged, in the late 1800s, the distortions of the sane world reflected themselves exactly in the worlds of the mentally ill.

The case histories and illustrations (many previously unpublished) that flesh out the text could form their own compelling book. They include ads for electric corsets to cure hysteria, a sheet-music cover for “Maniac Waltzes,” and a collection of keys made by would-be escapees. One patient’s haunting maps of his mental travels are reproduced, as is “landscape money” by the painter Ralph Blakelock, who suffered a nervous breakdown because of financial trouble and thereafter always carried a wad of bills that were actually landscapes painted on currencysized cloth. All are telling examples of the struggle to understand a world of illnesses still revealing itself today.