Madness and Modernity is an exceptionally well-conceived group effort that succeeds in avoiding the more speculative generalities often found in studies of “madness and art” in the twentieth century. By tracing the effects of specific contacts and commissions, the book offers a persuasive account of the intermingling of the city’s intellectuals and artists at such modern sites as “the coffeehouse, the cabaret, the sanatorium, and the secession building” (8). The result is a sound defense for including the sanatorium in any list of Vienna’s intriguing new modern attractions. Madness and Modernity originated as a research project begun by Lesley Topp and Gemma Blackshaw about “the impact of psychiatry on Austrian architecture and art practice” (8), and ended up involving a post-graduate participant (Sabine Wieber) as well as two doctoral candidates (Nicola Imrie and Luke Heighton). Their collaborative effort culminated in a linked monograph and exhibition.

The monograph begins with a study of the interactions between artists and architects on one side and practitioners in the field of psychiatry on the other in Vienna around 1900, a city that rightly enjoys a charmed place in discussions of modernity. A distinctive, revisionist feature of this book is its focus on the university- and institution-based psychiatric theory and practice that actually dominated the field, and which were therefore more influential socially and culturally than the still lesser-known works of Sigmund Freud.

The book is divided into two different types of chapters: those that treat particular contacts at some length, extending to a more historical and thematic treatment, and shorter ones that follow a case-study format, highlighting a limited number of objects. This is a very helpful combination, interspersing broader topics with focused accounts of specific items and the research steps undertaken to elucidate their histories. The longer chapters are devoted to: the relation of mental illness to a group of Oskar Kokoschka’s portraits (1910–11) commissioned by Adolf Loos (Blackshaw); a comparative study of asylum and sanatorium architecture, specifically Otto Wagner’s Steinhof and Josef Hoffmann’s Kurhaus for the Purkersdorf Sanitarium, and the relationship of modernity in architecture to madness (Imrie and Topp); the imprint of nerves and neurasthenia in Gustav Klimt’s early portraits of women (1898–1903) and their reception (Wieber); and mental disorder in the work of three Viennese literary figures, Peter Altenberg, Arthur Schnitzler, and Georg Trakl (Howes). Shorter case-study chapters address a pair of physiognomical wax sculptures (Wieber); a portrait of feuilleton writer and coffeehouse habitué Altenberg (Blackshaw); a model of the sixty buildings proposed in the presentation drawings for the Steinhof asylum (Topp); the artwork of an asylum inmate (Heighton); and two ceramic life-size female nudes designed for the exterior of the Purkersdorf Kurhaus (Wieber). All the chapters are well-served by a generous number of illustrations.

In their introductory chapter, “Scrutinized Bodies and Lunatic Utopias,” Topp and Blackshaw emphasize that artists and writers in Vienna were not just fascinated by madness, but also by the theories and practices of psychiatry, to the extent that these informed their creative outlook and orientation. Most prominent among these shared preoccupations was the conviction that the relationship between mind and body was a reciprocal one, and that urban society was in decay yet could only be cured or cleansed by these same processes of deterioration. There were ample opportunities for this meshing of art and medicine within the three branches of psychiatry then flourishing in Vienna—clinical psychiatry, institution design and management, and nervous disorders. Each branch had its own elaborations. Clinical psychiatry, while principally concerned with neuro-anatomy and the search for physical sites as the origins of specific diseases, also included the “descriptive, cataloguing impulse” (16) that embraced imaging. This approach had been influential in French psychiatry since the early nineteenth century, from whence its impact spread elsewhere. Later in the century, Jean-Martin Charcot at the Salpêtrière in Paris redoubled efforts in this descriptive area. Regarding himself as a “visuel”—as much an artist as a doctor—Charcot directed his institution’s image-making operations and the many publications associated with his work there. From the mid-century on, it was not unusual for most medical textbooks and journals in England and Europe to incorporate this practice of imaging patients’ traits and symptoms.

The second type of Viennese psychiatry focused on the design of psychiatric institutions. In this view, managing therapeutic care looked toward architecture and planning, and particularly utopian paradigms, in the search for creating curative environments. Nervous disorders, the third area, included non-psychotic ailments such as neurasthenia and hysteria, which were thought to be largely reactions to the pace and overall unhealthiness of modern city life. For this reason, sufferers from these ailments were thought to benefit from a curative environment distinct from their familiar settings.

Artists found the descriptive aspect of clinical psychiatry particularly appealing to their progressive creative interests. This sometimes resulted in inmate portraits (Kokoschka’s image of the writer Ludwig von Janikowski) or in the more traditional project of producing inmates’ images to accompany a psychiatrist’s lecture on expression (Erwin van Osen). Beyond likeness, some artists adapted qualities associated with patients, such as passivity and objectification, and merged these with their own creative interests in self-imaging, thereby achieving “a distinctively Viennese modernist rhetoric of anguish and alienation” (19). Egon Schiele’s engagement with the pictorial aspect of psychiatric discourse is evident in his self-portraits, and here there is the plausible claim that these were the artist’s response to Salpêtrière photographs of physically/neurologically “abnormal” men, in which they are shown alone, nude, beside a measuring stick, and against a plain background. Scientific in their artless awkwardness and seemingly unmediated presentation, the images orchestrated by Charcot nevertheless retained some of the more abject notes associated with Baroque religious art. A kind of medicalization of outlook, if not a “medical gaze” itself, drew artists associated with the Secession and the Expressionist movement to the medical discourse on sexualized, diseased bodies. This confluence of interest set the stage for critics likening, for example, innovations in painterly techniques to medical metaphors, as when Kokoschka’s brush was likened to a “surgeon’s scalpel” (25). Such elisions—the literalization of expressive mark-making—also expose the tendency to blur distinctions between mind and body, such that a diseased body would inevitably suggest or even mandate a diseased mind. Thus, an overly simplistic equation was capable of producing considerable backlash, as subsequent historical developments would show.

Architects and designers were attracted to the psychiatric branch that focused on asylum planning, where the acceptance of rational organization and social usefulness appealed to those no longer interested in historicist styles. Otto Wagner was particularly drawn to this kind of project because asylum planners shared his conviction that the built environment could be a powerful agent of transformation. In the visual economy of the asylum, the medical gaze displaced onto the structure a dynamics of “seduction and control” (32), positioning all viewers, whether patients or visitors, as passive elements within the potentially transformative setting. For Josef Hoffmann’s Kurhaus at Purkersdorf, the visitor would enter a rational, hygienic space whose repeated, square components were devoted to water therapy and various mechanical cures, a far cry from the uncontainable anxieties shown in the painters’ depictions. That there was some overlap between these disparate visions is tantalizingly suggested by some historically fugitive details, such as the ceramic figures intended to grace the Kurhaus exterior, which, whether muses or sirens, present an intriguing expressive amalgamation of ornament and ailment.

Madness and Modernity successfully demonstrates that in certain Viennese architectural circles—those of Wagner and his pupils—the spatial concepts of the medical-scientific community were welcomed and then adapted to their own progressive interests for asylum and sanatorium projects. The study clarifies how the descriptive, symptomatic appearance of disorder, affiliated with artistic traditions of physiognomy, expressive studies, and nineteenth-century psychiatric imaging, was increasingly integrated into portrait practices. There was perhaps even a new hybrid kind of “figurative decorative objectification”—focused on manipulations of face, hand, and flesh—that was not entirely removed from tendencies found in the artwork of patients. Finally, the pivotal role of reception is demonstrated in all the phenomena studied here, as potentially broader standards for appreciation and assessment were increasingly channeled by the rhetoric of criticism and public relations into the now familiar—contested—terms of disease.