Reviewed by Megan Q. Linton, Carleton University, Email: megan.linton@carleton.ca
Never has the contemporary global populace thought, critiqued, and relied more on the World Health Organization (WHO), than amidst pandemic. Mad by the Millions offers an evocative look into the politics, history, and relationships making up the 73-year-old transnational organization. Yi-Jui Wu’s book is a critical addition to the growing field of the history of madness, situated amongst the broader fields of history of medicine and global disability studies.
Extensively drawing on global archives and primary source documents, Wu follows the WHO’s tumultuous 50-year pursuit for standardized, global psychiatric diagnostics. The International Social Psychiatry Project sought to develop an international diagnostic classification of psychiatric disorders. This archival tracing of the WHO’s global psychiatry project reveals the political, interpersonal, and technical drivers central to the pursuit of global diagnosis.
This historical reckoning of the transnational psychiatric movement makes several significant contributions to Disability and Mad Studies and medical histories. Disability and Mad Studies have scrutinized the role of diagnosis, pathologization, and medicalization of mental disorders, but have primarily leveled critiques against the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Cooper, 2005; Lewis, 2006; Kirschner, 2013). Given that the DSM is an American construct, primarily utilized in the Global North, ongoing critiques maintain the exclusion of the Global South from Disability Studies literature. Wu intervenes in this gap, drawing crucial attention to the International Classification of Diseases. This intervention is a significant contribution to the field and creates an exciting opportunity for disability and mad studies scholars to expand their analysis of standardization and diagnostics to reflect transnational psychiatric systems.
The WHO’s global project illuminates the role of powerful psychiatric actors and the methodologies they engage to develop global psychiatric diagnosis amidst a broader organizational mandate. Wu introduces the reader to the central actors of the WHO’s world psychiatric project: Tsung-Yi Lin, Brock Chrisholm, Ronald Hargreaves, among others. The actors represent the three major psychiatric movements during the development of the WHO: military psychiatry, focused on the habilitation of soldiers; colonial psychiatry, focused on the ongoing subjugation; and biological and medical psychiatry, focused on pathologization and institutionalization.
Along with fundamental psychiatric trends, Wu pays careful attention to the development of post-war technologies of classification and data management in the pursuit of international diagnoses (p.121, 2021). The pursuit for standardized global data, the creation of statistical programming, and the development of new forms of media contribute to an exciting, yet underdeveloped, field of research connecting critical data studies and Mad studies (Dalton et al., 2016).
While pointing out these important threads, Wu steers clear of critique and analysis. He is overt about this from the beginning:“[u]nlike most critiques of psychiatric classifications, I do not haggle over the oppressive nature of such systems” (p.9, 2021). This is evidenced through the book, where Wu will reveal a shocking account of colonial violence, eugenical ideology, or scientific racism, but does not analyze its role in the project. For instance, the Global Psychiatry Project received financial support from the Milbank Memorial Fund in the 1950s (p.53, 2021). During this time, the Fund was directly connected through financial and directorial relationships with the American Eugenics Society (Ramsden, 2003). Yet, there is minimal consideration of the impact of this relationship on the Project. Histories of psychiatry do not have to be without critique, as evidenced by Managing Madness (Dyck & 2017), Colonialism and Transnational Psychiatry (Ernst, 2013), and of course, Colonial Psychiatry and the “African Mind” (McCullough, 1995).
The lack of analysis is not a criticism of this cutting-edge work, but rather an invitation for Disability and Mad Studies scholars to pick up on the crucial work that Wu has generously and rigorously provided. As a discipline with systemic failures to engage with disability and race, disability and the Global South, we must sink our teeth into this research, and emerge with transnational critiques of mental disorder diagnosis (Bell, 2006).
References
Bell, Chris. (2012). “Introducing White Disability Studies: A Modest Proposal.” In The Disability Studies Reader. 2nd ed. Ed. Lennard J. Davis. New York, NY: Routledge 275-282.
Cooper, R. (2004). What is wrong with the DSM? History of Psychiatry 15(1): 5–25
Dalton, C. M., Taylor, L., & Thatcher (alphabetical), J. (2016). Critical Data Studies: A dialog on data and space. Big Data & Society, 3(1), 205395171664834–. https://doi.org/10.1177/2053951716648346
Dyck, E. (2017). Managing madness : Weyburn Mental Hospital and the transformation of psychiatric care in Canada . University of Manitoba Press.
Ernst, W. (2013). Colonialism and transnational psychiatry : the development of an Indian mental hospital in British India, c. 1925-1940 . Anthem Press.
Kirschner, SR (2013) Diagnosis and its discontents: Critical perspectives on psychiatric nosology and the DSM. Feminism & Psychology 23(1): 10–28.
Lewis, Bradley. Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry. Ann Arbor: U of Michigan P, 2006. Print.
McCulloch, J. (1995). Colonial psychiatry and “the African mind” . Cambridge University Press.
Ramsden, E. (2003). Social Demography and Eugenics in the Interwar United States. Population and Development Review, 29(4), 547–593. https://doi.org/10.1111/j.1728-4457.2003.00547.x