The Journal of San Diego History
Spring 1980, Volume 26, Number 2
Thomas L. Scharf, Managing Editor


Richard H. Peterson, Book Review Editor

So Far Disordered in Mind: Insanity in California, 1870-1930. By Richard W. Fox. Berkeley: University of California Press, 1978. Note on Sources. Tables. Index. Notes. 204 pages. $10.00.

Reviewed by Allen Safianow, Associate Professor of History, Indiana University at Kokomo.

Richard W. Fox has written a valuable study of the social and cultural meaning of insanity in California, the state that led the nation in its rate of commitments at the turn of the century. His book actually focuses on San Francisco, which accounted for one-fourth to one-third of the state’s insane asylum commitments. Drawing on San Francisco Superior Court records, as well as on documents from other city, county, state and federal agencies, Fox attempts “to sketch, in its wholeness, the ideological, institutional, and professional network in which judgments of normality and abnormality took place and were enforced” during the period 1870-1930. He is particularly concerned with the commitment process and its social function.

Fox reports that those,committed in San Francisco were a heterogeneous group, with a disproportionate number found among blue-collar workers, the unmarried and the widowed. His evidence refutes the notion that foreign-born contributed more than their share and Phyllis Chesler’s claim in Women and Madness that females constituted the majority of “the psychologically involved population.” At the same time Fox acknowledges that women suspected of insanity were treated and regarded differently than men. The author however might have done more to explore different ethnic attitudes towards insanity, since the foreign-born formed a sizeable proportion, if not a disproportionate share, of those committed.

Only in a minority of cases, Fox contends, were commitment proceedings initiated because the accused were “so disordered in mind” that they endangered themselves or others, the legal criteria for commitment. Two-thirds of those committed found themselves in asylums because relatives, doctors, police or others viewed their behavior as inappropriate, bothersome or immoral. By the 1920s, there was a drop in commitments, in part because of the availability of voluntary outpatient care, and a distinction came to be made between the “mentally ill” — cooperative patients, not committed, who merited sympathy because they strove to labor productively despite a temporary affliction-and the “insane” — unproductive persons who resisted therapy and were likely to be committed. Despite this new sympathy towards the “mentally ill,” hospitals for the insane continued to have the same social function they had since the late eighteenth century, the detention of those who would not or could not conform to behavior expected of “normal” adults.

This work, based on Fox’s dissertation, is well written, carefuly researched, and perceptively deals with a complicated issue. The author stresses the need to advance beyond the concept of “social control” employed in David Rothman’s Discovery of the Asylum, and points out that the process of commitment evolved in San Francisco not only enhanced the power of the medical profession, but met the perceived needs of family members and the community. Fox, in line with the work of Michel Foucault, suggests that the cultural definition of insanity was in accord with a bourgeois emphasis on productivity. This argument is plausible if not conclusively demonstrated by the relatively few cases he employs as illustrations. The study ends in 1930, but if Fox is correct, one must ask what impact the Great Depression, with the vast unemployment it brought, and the evolution of David Riesmari s “other-directed” individual, oriented towards consumption rather than productivity, subsequently had on the social and cultural meaning of insanity. In any case, historians and interested lay people will find Fox’s book a useful contribution to a growing field of study.