Reviewed by Allison C. Carey
In Writing Mad Lives in the Age of the Asylum, Michael Rembis fundamentally shifts the conversation on the history of madness away from medical perspectives to center mad voices and experiences. To do so, he draws upon approximately one hundred first-person, nonfictional writings by former asylum inmates in the United States published between 1830 and 1950, supplemented with a vast array of other sources on madness. Through an analysis of these writings, Rembis transforms mad people in history from hollow shells legible only through diagnoses and professional records to complex agentic actors with rich experiences in navigating madness and complex relationships related to family, labor, and politics. Writing Mad Lives articulates and validates mad expertise in the conceptualization and treatment of madness, while demonstrating the harmful tactics used to discredit mad people.
Writing Mad Lives is organized into an introduction, nine chapters, and an epilogue. Each chapter explores key themes emerging from the collection of mad writing. While not strictly chronological, the progression of themes across the nine chapters reveals changes through time, including how mad writers and activists built a cumulative trajectory challenging asylum practices and demanding recognition of their expertise.
Chapters 1 through 5 focus on 1830 to 1890, a time when medical professionals were asserting control over madness and establishing and expanding the asylum system. Consequently, madness was gaining greater attention in public discourse. Chapter 1, “Claiming Madness,” explores former inmates’ motivations for public writing and their conceptualizations of madness. Mad writers leveraged their first-person experiences to assert expertise, including challenging medical professionals and the asylum system. Rembis documents the ways in which mad writers articulated madness as both an embodied experience and as a social condition which increased their vulnerability to social stigma and the loss of liberty. The veracity of mad writers’ claims by no means went unchallenged; indeed, throughout Writing Mad Lives, Rembis exposes the unethical tactics used by professionals to discredit mad knowledge. Chapter 2, “Committing Violence,” powerfully explores this tension between writers’ claims to expertise and discreditation by professionals, focusing on the issue of violence. Superintendents seeking to expand their control over madness and the press seeking profits amplified accounts of mad violence, warning “violent madness should be a community concern” (p. 39). Violence, however, was not a prominent reason for commitment. Mad writers, in contrast, discussed the violence they endured at home, in asylums, and at times at their own hands via self-harm and suicide attempts. Rembis stresses the active negotiation between mad people and others (e.g., professionals, family members) regarding diagnosis and treatment, as people in mental distress tried both to access help and retain control over their lives.
In chapter 3, “Writing and Work,” Rembis examines the strong conceptual relationship between madness and labor. Writers often discussed madness in relation to their ability to work and engage in self-care. For those earning money and/or engaged in self-care, commitment in an asylum disrupted their economic livelihoods and coping mechanisms, and therefore caused significant harm. Many writers advocated for the provision of care in the community, admitting that they needed help while disputing the benefits of institutional segregation. Once committed, asylum inmates performed “the labor of freeing [oneself] from the asylum” (p. 60), including tasks such as hiring a lawyer, recruiting others to advocate for one’s release, and documenting one’s sanity. Mad writing itself served as a form of labor used for economic gain, to join the conversation on madness, and to advocate for reform.
Chapters 4 and 5 focus on abuse in the asylum system and reform efforts. As in chapter 2, the themes of firsthand expertise and discreditation emerge as former inmates communicate tales of abuse, and medical professionals deny their claims, discredit them, and defend asylum practices. Institutional abuse has been widely documented, but reading inmates’ firsthand accounts evokes a visceral reaction from the reader as mad writers share stories of confinement, overmedication, boredom, and excessive force and abuse, as well as the loss of their livelihoods, relationships, and homes. Former inmates referred to asylums as a “den of death” and “prison houses” (p. 84). Chapter 5 turns to activism for asylum reform and establishing care in the community, paying particular attention to activists Elizabeth Packard and Clarissa Lathrop. Packard fought for the use of a jury as part of the commitment process, “postal rights” (access to uncensored mail, p. 115), and investigations into abusive institutions. Lathrop accused doctors of immoral conduct toward female patients and advocated hiring female physicians, removing abusive staff, and ending forced labor. Medical professionals demeaned Packard and Lathrop as delusional and reliant on “cheap sentiment,” while defending professional practices (p. 109). Rembis argues that mad activism yielded mixed success, but, even when they failed to enact specific changes, mad activists influenced the public debate and undermined confidence in medicine’s benevolence and efficacy.
Chapters 6 through 9 shift to a later era, 1890-1950, as the asylum transforms into the modern mental hospital, or at least as professionals promote the illusion of transformation. Insofar as physicians responded to asylum criticisms, rather than support home/community care, they instead sought to transform the asylum into a modern scientific mental hospital. They updated the names of professional organizations, attempted to standardize diagnosis and treatment, and established the precursor to the Diagnostic Statistical Manual. Rhetoric shifted from “custody” to “treatment and cure,” “inmates” to “patients,” and “insanity” to “mental illness.” Mad writers both adopted and challenged this modern medical approach. Many mad writers called themselves ill and strove for recovery; mad activist Clifford Beers built alliances with medical professionals to improve and standardize diagnosis and treatment. However, mad writers also revealed the continued ambiguity of diagnosis and the ineffectiveness and harm of treatments. Chapter 7 argues that, despite the rhetoric of a modern hospital, mental hospitals were underfunded, overcrowded, and often guided by eugenics. Treatments had little scientific basis. Instead of fostering recovery, the heightened interest in medical intervention led to experimentation, overuse of debilitating treatments, and overmedication. Rembis’s discussions of insulin shock and prolonged baths powerfully demonstrate the tendency toward implementing torturous interventions with little efficacy data. Rembis writes, “The great trouble with the modern mental hospital, according to Henry Collins Brown, was its complete lack of effective treatment” (p. 157). Mad writers like Brown “dismantled simplistic notions of medical progress” (p. 173).
Chapters 8 and 9 further document the agency, community building, and advocacy work of mad people. While in asylums, inmates offered critical knowledge and support to each other regarding survival. Inmate mutual care took on a formal role as well, as inmates performed much of the institutional labor. Once released, former inmates strove to establish systems of aftercare and to push for reforms. Rembis argues, “Though they were certainly not unified, early twentieth-century mad writers and their allies began to see themselves as part of a broad community and a longer historical trajectory” (p. 203) shaping public conversation, demanding reform, and confronting the challenge of reintegration. In 1937, former inmates founded Recovery Inc. and advocated a model of self-managed aftercare. Recovery Inc. criticized Clifford Beers’s work collaborating with medical professionals, arguing that it had yielded little that actually helped people in or out of asylums. Recovery Inc. stridently opposed harmful medical practices and demanded mad rights and care. The relatively short epilogue then explains mad studies and mad praxis and summarizes the key contributions of Writing Mad Lives.
Writing Mad Lives adds an outstanding contribution to the relatively recent and growing scholarship in mad studies, a field which centers the perspectives, experiences, and expertise of mad people and disrupts dominant discourses of mental health. Geoffrey Reaume’s 2009 Remembrance of Patients Past: Life at the Toronto Hospital for the Insane, 1870-1940, stands out for its use of patients’ first-person letters and accounts; while not claiming the umbrella of mad studies, in Committed: Remembering Native Kinship in and beyond Institutions (2020), Susan Burch uses a range of documents to center the lived experience of Indigenous peoples in the Canton Asylum for Insane Indians, a federal psychiatric hospital in South Dakota. Whereas these pathbreaking works focus on specific institutions, though, Writing Mad Lives attends to a wider set of experiences across states, time, and institutions. This expansive collection of mad writers enables Rembis to more broadly explore how mad writers articulate their own experiences and fight for reform.
Much scholarship dates mad activism to the psychiatric survivors movement emerging in the 1960s and to Clifford Beers’s mental hygiene movement of the early twentieth century; however, Rembis’s work captures activism well before those pivotal moments. Readers gain exposure to people who published, lectured, fought to change laws, participated in institutional investigations, and created reform organizations. The themes that emerge—for example, the embodied experience of madness, social stigma and the loss of freedom, alternative visions of care and treatment, the hostility of medical professionals to mad criticism, activism to ensure human and civil rights, community building and communal care—continually position mad people as agentic, as experts, as complex humans negotiating, laboring, building community, and thus as active and informed participants in their own lives and in public conversations about madness.
Throughout this expansive and important book, Rembis maintains an accessible and compelling writing style. The chapters are relatively short, the stories take center stage, and the themes are clearly evident but never bogged down by scholarly tangents. Therefore, Writing Mad Lives is highly appropriate for classroom use with undergraduate or graduate students.
As with every book, there are some limitations. First, although Rembis discusses class and gender, his attention to “mad writers” as a collective overshadows an intersectional analysis. Readers, for example, briefly hear that activist Clarissa Lathrop accused doctors of immoral conduct toward women, and that critics of activist Elizabeth Packard described her as a “talkative crazy woman” (p. 109); however, there is little attention to the ways that gender (or other social categories/identities) shaped perspectives, experiences, or activism. Second, and related, Rembis acknowledges that his choice of data leads to a collection of almost exclusively white authors; he states that “race structures this story” (p. 4), but it does so largely by its invisibility. While noting this limitation, he does little to remedy it.
Finally, the epilogue is relatively short, which will serve some audiences well; however, Rembis may have missed an opportunity to connect the themes in Writing Mad Lives to modern experiences and to broader scholarship. In thinking about contemporary times, many similarities sadly exist, such as abuse in mental hospitals, the loss of rights, the challenges of negotiating family relationships, the widespread myth of mad people as violent, and the resistance of medical professionals to the expertise of mad people. On the other hand, significant differences could have been discussed briefly, such as the rise of the prison industrial complex as a primary provider of mental health “care” and the growing visibility of mad voices in communities unrepresented in his collection, such as BIPOC and LGBTQ+ communities. Rembis might also have chosen to expose readers more explicitly to the broader scholarship in mad studies and disability studies by connecting his themes to those found more widely. His references are certainly extensive but require reading endnotes. Thus, a novice to the field will not easily learn or see connections to broader scholarship.
In conclusion, Writing Mad Lives in the Age of the Asylum offers an exceptional contribution to disability history and mad studies. Drawing on previously untapped first-person accounts to center the lives of mad writers, Rembis recognizes the agency and insight of mad people to reconceptualize madness, the asylum, and the delivery of care. The accessible and compelling writing style makes Writing Mad Lives a pleasure to read. I urge everyone with even a tangential interest in madness, mental health, disability history, disability studies, activism, life writing, or institutionalization to read this valuable work.
Editor’s Note: This review was originally published in H-Disability and is reprinted in Wordgathering with permission. Any questions or concerns about the original publication’s accessibility can be directed to H-Disability.
Title: Writing Mad Lives in the Age of the Asylum
Author: Michael A. Rembis
Publisher: Oxford University Press
Date: 2024
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About the Reviewer
Allison C. Carey is Professor of Sociology, Chair of the Department of Sociology & Anthropology, and founding director of the Interdisciplinary Minor in Disability Studies at Shippensburg University. She is author of Disability and the Sociological Imagination (2022) and On the Margins of Citizenship (2009), co-author of Allies and Obstacles: Disability Activism and Parents of Children with Disabilities (2020), and co-editor of several collections including Family and Disability Activism: Beyond Allies and Obstacles (2025) and Disability Incarcerated (2015).