Madness, Psychiatry, and the Visual Arts in History

Psychiatric TimesVol 33 No 2
Volume 33
Issue 2

While much in the history of “madness” has changed over the course of time, one of the most consistent-yet sometimes overlooked-features of that history has been the presence of the visual arts.


While much in the history of “madness” has changed over time, one of the most consistent-yet sometimes overlooked-features of that history has been the presence of the visual arts. Dating back to ancient times, observers have attempted to understand and communicate the meaning of mental illness through paintings, drawings, sculpture, and ceramics and, later, photography and film.

Indeed, some of the most enduring images of what used to be called “insanity” and its treatment have been crafted by artists. Think of William Hogarth’s portrayal of Bedlam Hospital (1735); Charles Louis Muller’s depiction of Philippe Pinel removing chains from the insane; or Andrea Brouillet’s A Clinical Lesson With Charcot at the Salpêtrière (1887). To many, art has been seen as uniquely qualified to provide insight into both those deemed mad and their self-professed healers.

[[{"type":"media","view_mode":"media_crop","fid":"46111","attributes":{"alt":"© ARTPARTA/SHUTTERSTOCK.COM","class":"media-image media-image-right","id":"media_crop_4654818004928","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5323","media_crop_rotate":"0","media_crop_scale_h":"165","media_crop_scale_w":"150","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"© ARTPARTA/SHUTTERSTOCK.COM","typeof":"foaf:Image"}}]]The histories of the visual arts and madness, however, are even more tangled than this. As Gail A. Hornstein, PhD,1 recently pointed out in an essay in the British magazine The Psychologist, art proved to be an integral part of clinical research and treatment dating back to the building and proliferation of asylums in the 19th century.

Hornstein is Professor of Psychology at Mount Holyoke College. She is the author of numerous articles and books, including Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness.2 Throughout her career, she has been committed to recovering the voices and personal experiences of those living with mental illness. In fact, her Bibliography of First-Person Narratives of Madness in English3 has long been a canonical resource for many of us historians.

As Hornstein notes, prominent alienists-as asylum healers were called in the 19th century-and psychiatrists since the 1830s believed that the visual arts had a role to play within asylums. Jean Etienne Esquirol (Salpêtrière) turned to paintings and drawings, while Hugh Welch Diamond (Surrey County Lunatic Asylum) and Jean-Martin Charcot (Salpêtrière) took advantage of the new technology of photography to capture images of their charges.

Their purpose was 2-fold: either to “freeze the features” of patients to allow physicians an opportunity to more effectively identify physiognomical anomalies or to freeze the behavior of “lunatics” in order to flag patterns and discrete stages in their actions. In both cases, however, the ultimate intent was to help refine diagnosis.

In the early 20th century, some psychiatrists took a different approach to visual media. During World War I, German psychiatrist Max Nonne filmed his shell-shocked patients-dubbed “war neurotics” at the time-as a way to demonstrate to students and other clinicians both the symptomatology of the disorder as well as his techniques for treating it. (The film is available online from the German Federal Archive; it can be viewed at:

At the Psychiatric Clinic at the University of Heidelberg, Hans Prinzhorn began collecting the artworks of psychiatric patients throughout central Europe in 1919. His aim was to explore what he believed to be the common, fundamental purpose of all creative activity: forging links between self and other. All told, Prinzhorn collected around 5000 paintings, drawings, sculptures, textiles, and installations by some 500 individuals. Some can still be seen today at the Prinzhorn Collection in the University Clinic in Heidelberg. As Gail Hornstein concludes in her essay:

From the colourful PET scans of the so-called “schizophrenic brain” that now fill psychiatric textbooks, to the cartoon images of neurotransmitters in pharmaceutical advertisements, to the extravagant performance art created by activists in today’s mad movement, images of madness are everywhere. I myself think that the only meaningful approach is to start with the lived experience of individuals, contextualising their “madness” within the rest of their life story and experience.1

To this day, the visual arts remain a vibrant part of the world of mental health care.


More on the History of Psychiatry

The 10 Most Important Changes in Psychiatry Since 1945: An Invitation to Readers

The events that were cited as the most important changes since World War II.

Can Climate Be Hazardous to Your Mental Health? A View From History

It is clear that unless things change radically in the coming decades, psychiatry-like other branches of medicine-will have to accommodate itself to the effects of disruptions to existing ecosystems.

The Psychiatrist, the Aliens, and “Going Native”

After years of working with troubled individuals claiming to have been abducted by extraterrestrials, Harvard University Professor John Mack published a book. What made Mack and the book so controversial was the fact that he had come to accept that his patients’ stories were an accurate description of real events.


This article was originally posted on 12/15/2015 and has since been updated.


Dr Eghigian is the History of Psychiatry Section Editor for Psychiatric Times. His full bio can found here.


1. Hornstein GA. Madness from the outside in. Psychologist. 2015;28:1028-1031.

2. Hornstein GA. Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. NY: Rodale Books; 2009.

3. Hornstein GA. Bibliography of First-Person Narratives of Madness in English. 2011. Accessed December 21, 2015.

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