Book excerpt: Since the earliest medical, philosophical, and literary texts in ancient civilizations, madness has posed some basic issues: how to separate sanity from insanity, to distinguish mental and bodily illnesses, and to specify the variety of internal and external forces that lead people to become mentally ill. This book explores the answers to these questions that have emerged over time and concludes that current portrayals are not much improved compared to those that emerged thousands of years ago. The puzzles that madness presents are likely to remain unresolved for the foreseeable future and perhaps forever.