This is an extraordinary book, but not in a good way. Explicitly referencing Durkheim’s polemical choice of suicide as a dramatic way to demonstrate the power of the social, Liah Greenfeld has set out to provide a sweeping demonstration of the importance of culture in human affairs by choosing two major forms of psychosis––schizophrenia and manic depressive illness––that she claims are widely perceived to be rooted in biology, and then proceeding to “prove” that “these biologically real diseases are culturally caused, that they are products of culture” [1]. This would be a remarkable accomplishment, were it to be realized, since the etiology of both disorders in reality remains thoroughly elusive. Claims that they are simply the product of biological factors are bio-babble, not science, a metaphysical wager, not something with solid empirical grounding. The same, I am afraid, must be said of Dr Greenfeld’s alternative explanation.

One of the prodromal symptoms of schizophrenia, according to the German psychiatrist Klaus Conrad, involves discerning patterns in the world that are in reality delusional, a phenomenon that has come to be called apophenia. Such delusions are experienced by the psychotic as revelatory, and Dr Greenfeld clearly feels that she has had a revelation about the causes and the incidence of madness that others have previously ignored or been blind to. Many of the patterns Dr Greenfeld claims to have discovered will come as an enormous surprise to most of those who have examined madness in cross-cultural and trans-historical perspective. I was surprised to learn, for example, that “For at least two hundred and fifty years [beginning in Elizabethan times], madness appeared to affect only England and the British dominions, and was, judging by all accounts, entirely absent from the European Continent.” It was centuries before it appeared elsewhere: “when nationalism developed in France by the end of the eighteenth century, madness arrived there too, and later—with nationalism—spread to the German principalities and Russia.” I confess I am tempted at this point to quote the great John McEnroe: “Surely you can’t be serious?” But I will refrain for the moment, and inquire further into this novel set of observations, unique as far as I am aware among historical accounts of madness.

The English, we are told, became a nation under the Tudors. In the lives of the English, God now became an irrelevance: nationalism is a secular ideology, and God therefore inevitably faded from memory. Death was stripped of its sacred significance. England became modern overnight, and one symptom of that transition to modernity, and one that would not find parallels elsewhere for centuries, was that the English language was abruptly modernized, a necessary step before people could grasp the new existential realities. “The process of the ‘modernization’ of English language, thinking and experience was complete by 1600, certainly by 1610” and “Modern reality […] [later] arrived in the rest of the world as a translation from English [313]. Nationalism created the autonomous individual, and the English “set their own destinations in life and more often than not traveled alone, leaving behind families of their origins, pulling out roots without regret” [317]. Ambition ruled, and brought about the characteristic sufferings of the modern age. “I must pause here and make a special announcement, so counterintuitive and shocking is what one is about to read: Ladies and gentlemen, love too was invented in sixteenth century England” [322]. And not just love: “it should no longer come as a surprise that happiness became possible only in the sixteenth century and that the only place in which, for some time, it was possible was England [338]. The dark side of sixteenth century England’s blessedness was, however, that chronic madness now began to stalk the stage for the first time. Cue lengthy summaries of Shakespeare to prove the point. When Shakespeare jokes in Hamlet that the Prince has left for England, because there his madness will not be noticed, since all are as mad as he, why what else could he possibly be referring to but the new salience of madness. For madness most assuredly is born here and here only, the bastard offspring of modernity or, more properly speaking, of that which is the central feature of modernity, nationalism. For here is “the central argument of this book”: that it “connects in a causal relationship the cultural phenomenon of nationalism and psychiatric diseases of unknown origin” [2]. Unknown no more, for Dr Greenfeld has uncovered the truth, psychiatrists take note.

Remarkable assertions like these are scattered all through what is at first sight a very long book—indeed, is a very long book, running to almost 700 pages. The bulk of what makes up the prose, however, is not really Greenfeld’s own writings, but rather pages and pages of lengthy quotations, interspersed with paraphrasings, from a handful of authors whose work she has read. For a discussion of schizophrenia, we are treated at length to a regurgitation of the writings of Louis Sass. We get gobs and gobs of Bleuler, the man who invented the term “schizophrenia,” and pages and pages of Kay Jamison’s memoir of her own madness. Shakespeare is mined relentlessly for pages and pages of quotes about madness. And so it goes. Every now and then, Greenfeld inserts a tendentious comment about what it all means, and how all this text, reinterpreted through her consciousness, reinforces her theory that madness is simply the end product of nationalism.

Anecdotes, seemingly chosen at random, are thrown at us as if they were evidence. Greenfeld can read Jamison’s account of her manic depressive illness, or Sylvia Nasar’s account of John Nash’s schizophrenia in A Beautiful Mind and at once make complete sense of what was going on in both cases, and what triggered their madness. For two centuries and more, psychiatrists and their predecessors have puzzled over what provokes psychoses like these. Behold, the answer is now at hand. Our intrepid scholar of nationalism reveals all. The blithe self-confidence with which she reanalyzes Kay Jamison’s problems is remarkable. It was a matter of “insecure selfhood […] she is interested only in status and not in any specific problem in psychiatry” and her real problem is “deep dissatisfaction with identity” [300], a loss of what makes life meaningful, and these are the pathological consequence of nationalism and modernity (which for Greenfeld are one and the same). As far as I know, Jamison (and Nash, for that matter) are not people the author has ever actually met, let alone got to know. And yet she is utterly and completely sure that she knows what ails them, and what its ultimate causes are. And the lessons for the rest of us are equally plain and transparent: “what we, as a society, should prevent, is giving our children the choice to be self-centered.” That will do it.

To have discovered the pattern that explains individual mental pathology would be one thing, but Greenfeld is convinced that her revelations also allow us to understand much else besides. Modern literature has its peculiarities? That is because of “the role schizophrenic mental disease played in shaping [it].” Poetry? “English language modern poetry, it now appears to me undeniable, has been a creation of madness” [616]. Moreover, “the role of madness in shaping modern literature has not been confined to the English-speaking world [which now also has its nationalisms] and neither has it been confined to one particular genre” [301]. It accounts, for example for the whole phenomenon of Romanticism. Greenfeld describes “these literary discoveries as a ‘shock,’” but not as much of a shock perhaps as her next revelation. For her discovery of the vital role of nationalism via madness at last has allowed her to make sense of “the specter of Karl Marx” [601]. Madness, it seems, was “the inspiration for Marxism” [602]. And if that is not enough, “it is obvious that madness has changed the very nature of violent crime, dramatically increasing the irrational element in it” [629].

I confess that as someone who has spent a lifetime examining the interrelationships between madness and civilization, and striving to make sense of the depredations that visit both the individual and society when connections with commonsense reality are lost and life’s emotional moorings are cut loose, I was completely out of sympathy with the portrait of madness presented here. It seemed to me so bizarre, so solipsistic, so lacking in connections to any substantial knowledge of the relevant subject matter, so convinced of its own validity though heedless of any systematic review of relevant evidence or any knowledge of what insanity has meant across time and place, that I was at a loss to understand how it had appeared under the imprint of a major university press. Its historical portraits of early modern England, let alone European nation states in the same period, would baffle and infuriate any historian with even the most elementary knowledge of the periods she purports to discuss. And composing a book largely from snippets of what others have had to say, with interpolated corrections to show us what conclusions they ought to have reached makes for a dreary, drawn-out text.

Liah Greenfeld describes her reinterpretation of Kay Redfield’s memoir of her madness as “harsh. But I want to stress that it implies no moral judgment” [306]. This review has been at least equally harsh. I am not so sure that the same cannot be said of my moral and its intellectual judgments. But there we are.