Both Andrew Scull and Allan Horwitz write about psychiatry and mental illness, but they approach the subject from different angles and reach somewhat different conclusions, even when they cover similar ground.
Scull is a historian, and his work reflects that. He traces the rise of institutional psychiatry over centuries, asking how and why society came to medicalize deviant behavior and place it under the authority of doctors. His most celebrated book, Museums of Madness: Social Organization of Insanity in 19th Century England, examines the rise of the asylum in England, and his later Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud offers a sweeping history of mental illness from antiquity to the present. Scull tends to be skeptical, even caustic, toward organized psychiatry. He sees the profession as having repeatedly overstated its knowledge and authority, from the 19th-century asylum keepers who promised cures they could not deliver to modern biological psychiatry’s confident claims about brain chemistry. His book Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness catalogs treatments that caused enormous harm, often carried out by well-intentioned doctors who convinced themselves that crude interventions worked. Scull does not argue that mental illness is a myth, but he does argue that the history of psychiatry is a history of professional ambition often outrunning genuine understanding.
Horwitz is a sociologist, and he focuses more tightly on the present. His most influential work, Creating Mental Illness, argues that modern diagnostic psychiatry, particularly after the DSM-III in 1980, stripped context from the definition of disorder. By eliminating the distinction between contextually appropriate distress and genuine dysfunction, psychiatry inflated the prevalence of mental illness and made normal suffering look like pathology. He developed this argument further in The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, co-authored with Jerome Wakefield, which focuses specifically on depression and argues that much of what psychiatry diagnoses as a disorder is a proportionate response to loss or adversity. More recently he has written about anxiety in a similar vein.
The two share considerable common ground. Both view the expansion of psychiatric diagnosis with suspicion. Both argue that social forces, professional interests, and institutional pressures shape what gets called mental illness. Neither is a straightforward antipsychiatry polemicist in the Thomas Szasz mold, but both question the authority and precision that mainstream psychiatry claims for itself.
The differences are real, though. Scull writes with historical depth and tends toward the dramatic. He takes the long view, which lets him show how confident each generation of psychiatrists has been about theories that later collapsed. The rhetorical weight of his work comes from that accumulated evidence of failure and hubris. Horwitz writes more narrowly and sociologically. His argument is less about institutional overreach across centuries and more about a specific conceptual mistake embedded in contemporary diagnostic categories. He wants to fix something precise: the failure to distinguish disorder from distress. Where Scull tends toward indictment, Horwitz tends toward critique and reform.
Scull also engages more directly with the experiences of patients and the material conditions of institutions. His history of madness has a human texture that Horwitz’s sociological analyses sometimes lack. Horwitz argues at a more abstract level about categories and definitions, which makes his work precise but occasionally dry.
One tension worth noting is that Horwitz, despite his critique of diagnostic inflation, still works within a framework that accepts the concept of genuine mental disorder. He wants better distinctions, not the elimination of the category. Scull is harder to pin down on this. His historical work raises deeper questions about whether psychiatric categories have ever tracked anything stable in nature, without fully resolving that question. He is more comfortable sitting with the uncertainty.
Together they make a useful pair. Scull provides the historical sweep and the sense of how deep the problems run. Horwitz provides a more targeted analytical argument about what went wrong at a specific moment and why it matters. Reading them together gives you both the long arc of the problem and a precise account of its contemporary form.
Further Reading
Thomas Szasz wrote The Myth of Mental Illness in 1961, and it remains the most radical challenge to psychiatric authority ever written. Szasz argued that mental illness is not a genuine medical category but a metaphor that society uses to manage behavior it finds inconvenient. Most serious scholars today reject his strongest claims, but the book forced psychiatry to defend assumptions it had never examined, and its influence on Scull and Horwitz is real even when they distance themselves from it.
Michel Foucault’s Madness and Civilization is essential despite its historical unreliability. Foucault argued that the confinement of the mad in the 17th century represented a great silencing, a moment when reason expelled unreason and defined itself against it. Historians have picked apart his evidence for decades, but his central insight about how psychiatry constructs and controls the mad rather than simply discovering and treating them shaped an entire generation of critical scholarship.
Robert Whitaker‘s Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill and its successor Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America make a more empirical argument about biological psychiatry and psychiatric drugs. Whitaker examined the long-term outcomes for people treated with antipsychotics and antidepressants and found the evidence for their benefit far weaker than the profession claims. He is a journalist rather than an academic, and his critics argue he cherry-picks evidence, but his work raises questions that mainstream psychiatry has not answered cleanly.
Erving Goffman’s Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates deserves a place here. Goffman spent a year observing St. Elizabeths Hospital in Washington and developed his concept of the total institution, a place that strips individuals of identity and remakes them according to its own logic. The book is sociology rather than history, but it permanently changed how researchers think about institutional life and the relationship between diagnosis and social control.
Edward Shorter’s A History of Psychiatry: From the Era of the Asylum to the Age of Prozac argues the opposite of Scull. Shorter is a genuine believer in biological psychiatry and treats its history as a slow, painful progress toward scientific truth. The book is useful precisely because it makes the strongest case for the other side. Reading Shorter alongside Scull gives you a genuine debate rather than a chorus.
Anne Harrington’s Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness is more recent and more measured. Harrington, a historian of science at Harvard, traces psychiatry’s repeated attempts to ground mental illness in biology, from 19th-century brain anatomy to the neuroscience revolution of the late 20th century. She argues that each attempt has run into the same wall: the brain is too complex and mental illness too heterogeneous for the reductive models psychiatry keeps reaching for. The book is sympathetic to psychiatry’s ambitions while being honest about its failures.
Gary Greenberg’s The Book of Woe: The DSM and the Unmaking of Psychiatry is a sharp and often funny account of the making of the DSM-5. Greenberg, a practicing therapist and writer, got unusual access to the process and documented the politics, fights, and compromises that produced the manual. It reads like journalism but carries serious analytical weight and connects directly to Horwitz’s argument about diagnostic inflation.
Christopher Bollas and David Sundelson wrote The New Informants: The Betrayal of Confidentiality in Psychoanalysis and Psychotherapy, a narrower book about confidentiality and the state, but it touches on larger questions about what psychiatry owes its patients versus what institutions demand of it.
Finally, Nikolas Rose’s Governing the Soul: The Shaping of the Private Self and his later Our Psychiatric Future bring a Foucauldian lens updated for the neoliberal present. Rose argues that modern psychiatry and psychology do not simply treat suffering but produce new kinds of subjects, people who understand themselves through psychological categories and manage themselves accordingly. His work is dense but rewarding, and it connects the history both Scull and Horwitz write to broader questions about governance and selfhood.
