Nineteen Eighty-Four (1949), George Orwell’s political satire on state surveillance and mind control, was written between 1946 and 1948, at a time when new thinking in forensic psychiatry coincided with scientific breakthroughs in neurology to bring questions of criminality, psychotherapy and mental health to the forefront of the popular imagination. This paper examines how Nineteen Eighty-Four inverts psychiatric paradigms in order to diagnose what Orwell sees as the madness of totalitarian regimes. It then goes on to place the novel’s dystopian vision of total surveillance and mind control in the context of the neurological research and brain scanning techniques of the mid-20th century. Not only does this context provide new insight into the enduring power of Orwell’s novel, it also locates it within a historical moment when technological interventions into the brain seemed to offer a paradigm of mental health and illness as a simple, knowable binary. Nineteen Eighty-Four complicates this binary, and deserves to be acknowledged as an early example of what might be called ‘electric shock’ literature, within a mid-20th century canon that includes Harold Pinter’s The Caretaker (1960), Ken Kesey’s One Flew Over the Cuckoo’s Nest (1962), and Sylvia Plath’s The Bell Jar (1963).