I was born in a small village in the Netherlands in the 1960s. At the time, several relatively large mental hospitals operated in the Netherlands and I grew up next to one. During my childhood, I quickly became aware of several advantages of this situation. The woods around the hospital were deserted—hardly anyone went there for recreational walking. It thereby became ideal territory for me and my friends to build huts, blaze new trails, hide treasures, and make new discoveries. Of course, we often bumped into patients who were working in the hospital gardens, and later I realized I had been observing the many side-effects of the medications that were then used to treat mental illness (or, at least, diminish the symptoms). This did not always work and at times the screaming of patients in isolation cells could be heard. Even though I have been very close to the many pavilions of the mental hospital, its inner workings remained mysterious to me. I probably did not want to imagine what took place there.
Occupational therapy was implemented widely in this mental hospital, as patients worked in the gardens and built all kinds of things in the many workshops. My family bought many pieces of furniture there. I noticed a change in approach when we could no longer just order pieces of furniture but had to wait and see whether a patient wanted to take the project on. Democracy in the workshop probably benefited the patients working there, even if it inconvenienced an impatient teenager.
The annual fête was of course the highlight of the year. There were lots of fun activities, games, and competitions, the highlight of which was the soccer match between the physicians and the other employees of the mental hospital (the physicians always lost). Stuffed animals, toys, artworks, and other things made by patients were offered for sale. At times even well-known Dutch pop groups (naturally unknown anywhere else in the world) would perform.
Next to the mental hospital was an institution for children with mental retardation. Initially I did not notice them very much. One day, a new treatment method was implemented in our neighborhood: three residential units were built there, with the aim of bringing inhabitants closer to the community. Our chickens benefited enormously, as inhabitants came by quite regularly with left-over food for them. This residential project has now been phased out, as treatment fashions have changed once again.
My connection with the mental hospital was quite close, in particular because my father worked in the out-patient clinic there. Naturally, I was quite proud that my father did not lock people up but actually made them better so they could stay at home. My interest grew even stronger when I overheard many discussions between my father and my aunt, who was a psychoanalyst. She thought my father’s eclectic and Rogerian approach would do no good because it ignored the fundamental insights of Sigmund Freud. The high point of her life was when she attended a play when Jeanne Lampl-de Groot (who had been analyzed by Freud himself) was in the audience as well. The many endless discussions between my father and my aunt allowed me to develop, at an early age, the skill to bring up topics of conversation (such as new girlfriends, accomplishments at school, or family scandals) that would focus their attention of more appetizing topics.
Entering university brought me in contact with the theories of Michel Foucault, which I read with my fellow students. Our resolve to understand his work fully was reinforced by our perception that our philosophy teachers had discouraged us from reading his work—there are, naturally, distinctive rewards for being subversive. I also read some theories about the psychologization of Western society—theories which state that psychiatrists had taken the place of priests and ministers in exerting social control. Such theories shed a whole new light on my father’s work—rather than merely helping patients, he was part of a vast and powerful conspiracy that determined the innermost aspects of human subjectivity. At that point, I knew what I wanted to do: I planned to unearth the origins of that vast conspiracy and reveal its inner workings. To finish up my studies in the Netherlands I wrote a thesis on how the power of the catholic church in the Netherlands was reduced through their reliance on psychotherapists (who promised to clear up a general level of immaturity among wayward catholics, which would make these people more appreciative of the church once again; unfortunately when they matured, they ran from the church in droves). After that I moved to North America to investigate the history of the mental hygiene movement. After all, the psy-complex came from the United States and its most powerful embodiment was this movement.
After several years of research, I realized that the rhetoric of the mental hygienists I investigated surely matched my wildest dreams—but their accomplishments were far more modest than their rhetoric. I also became aware that several other forces (be they a modern capitalism, a culture of consumption, the mass media, or narcissism) could be responsible for the social changes for which I had blamed psychiatry. In addition, I realized that Western society was far less psychologized than I once thought—Manhattan and parts of Los Angeles and San Francisco, where every self-respecting individual would occupy a couch for at least a few years, had surely been taken over by the psy-complex, but many other places in America (i.e. the mid-West) and the rest of the so-called civilized world had proven to be far more resilient. And how could it have been any different? Mental hygienists, after all, were a small minority among psychiatrists, and a minority that received hardly any respect to boot. In addition, psychiatrists have long been one of the least respected medical specialties. How could a minority within one of the least respected medical specialties muster the power to reshape western culture? Naturally, more bizarre things have happened, but they would need to be explained by arguments coming from outside the historical profession. I now became utterly fascinated by the interest psychiatrists had in the work of some of the followers of Foucault. If they could not be saviors of humankind, they could at least be its villains?
Even though my early hunches about psychiatry and the psy-complex had proven to be mostly unfounded, the discipline continued to pique my intellectual interests by challenging earlier ideas and assumptions. Ironically, I had become interested in the psychologization of Western society when psychiatry was increasingly becoming biological in orientation (and, predictably, many commentators have started discussing the psychopharmacologization of Western society). In a relatively short period of time, an interest in the mind and a focus on psychotherapy lost its dominance, to be overtaken by an interest in the inner workings of the brain and the pharmacological treatment of its aberrations (leading to today’s almost religious interest in the brain as the organ that can explain the full range of human behavior). Mental hygienists had at least emphasized social and cultural factors—and the few radicals among them had focused on political and economic variables. Somehow psychiatry seemed to respond rather quickly to such changes—or was it that social commentators with great interest in psychiatry had changed their opinions? Everyday psychiatry probably changed less rapidly than psychiatry as it was presented in the media. And everyday psychiatrists are probably baffled about all the claims made in the media about their profession.
Marrying a psychiatrist provided me with new insights on the profession. When my future wife first visited my office, she was completely shell-shocked after browsing through several books detailing the evils of psychiatry. A few weeks later, when she was on call, I overheard her having several conversations in which her sole aim was to keep people out of the psychiatric ward of the hospital (which was already filled to capacity). Instead of revealing an impulse related to the great confinement, she deftly and strategically made decisions on how the resources of the hospital could best be made available. This also opened my eyes that many individuals wish to be admitted—for a variety of reasons, most of which are not related to the actual benefits admission could provide. Today, it appears that the demand for psychiatric services (in particular psychiatric medications) far outstrips what can realistically be expected of them. Similarly, the popularity of brain-based explanations of behavior far outstrips what scientific research has proven. In other words, there is a not entirely wholesome public fascination with psychiatry which does not correspond to the ways psychiatrists view what they are able to deliver.
As is apparent from these statements, I have been fascinated by psychiatry and psychiatrists for most of my life, although the reasons for my interests have changed over time. I can certainly see myself retaining this interest for the foreseeable future.
Unit for History and Philosophy of Science
University of Sydney