This book, written in part by a psychiatrist with expert knowledge of schizophrenia, addresses the question of why mental illness has become increasingly pervasive since 1750. Starting with this date and proceeding towards the present, Torrey and Miller make a commanding case that the prevalence of mental illness has increased steadily since the age of Enlightenment, at least in English-speaking countries. The argument is forceful.

They argue against the common argument - pushed forward by many in prominence like Michel Foucault - that the diagnosis of insanity/psychosis is merely a way of pushing away societal nonconformists into asylums. The finding of MRI changes in those with bipolar disorder or schizophrenia, for one, argues for some kind of biology of disease, not merely a sociology. Further, the contention that genetics provides a key does not answer the question: What in modernity has led to the spread of mental diseases? Why did we not see this prior to 1750?

The authors propose a wide variety of possible (but unconfirmed) causes, all centered around the hypothesis that urbanization plays a key role. This case is well-argued and deserves attention and research.
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Author Fuller sets forth a chilling description of the rising flood of mental illness in the U.K., Canada, Ireland, and U.S. over the last 250 years with in-depth figures, historical reports, government inaction, and outlines of possible causes of mental illnesses. As Fuller himself concludes, “Epidemic insanity remains one of the great enigmas of contemporary medicine and demands novel approaches in thinking about its causes.” In no small part due to the deinstitutionalization of the mentally ill, there is no accurate count of their numbers or their whereabouts in society. Failure to recognize the problem of the mentally ill who walk among us has led to a catastrophic failure to identify, track, and treat them." ( )