Author Archive

The History of the Nervous Breakdown

The New York Times has a small piece discussing the history of the notion of “the nervous breakdown.”  Quoting historians Peter Stearns and Edward Shorter, the article notes that the term’s persistence and popularity, in large measure, has derived from its relative vagueness as well as its apparent lack of medical connotations.  The history of what counts as “vagueness” and “precision” in clinical nosology, diagnosis, and prognosis at any given time is an issue worthy of closer empirical study.  For those interested in pursuing this further, have a look at the article by Barke, Fribush, and Stearns, “Nervous Breakdown in 20th Century American Culture.”

Gender and the History of Integrated Wards

Coverage of some recent violent attacks on female patients in mental health facilities in Milwaukee County in the U.S., prompted a medical journalist to contact me with an interesting set of questions – ones for which I had no ready answers.  Perhaps, some readers and subscribers of H-Madness have some thoughts on the subject.  When did mixed-gender wards and units begin to emerge in psychiatric facilities?  How widespread have these historically been?  Were they the results of institutional pressures in the wake of de-institutionalization?  Were they a function of changing ideas about reintegrating institutional patients in society following World War II?  Or do they have a longer history?

Mass Media Depictions of Mental Illness

PsychCentral has a pithy piece by Margarita Tartakovsky that discusses some of the common stereotypes found in mass media representations of people suffering from mental illness (Click here to see the article).   Some of the most common being that:  people with mental illnesses are prone to violent outbursts; the mentally ill are unpredictable;  depression is caused by a chemical imbalance.  All of these contain some measure of truth, of course, but are grossly exaggerated in the media. Particularly noteworthy is discussion of I. Schneider’s 1987 sketch of three conventional ways in which the movie industry over the course of the 20th century scripted psychiatric professionals – as evil (Dr. Evil), foolish (Dr. Dippy), or wonderful (Dr. Wonderful).  Not only could the same be said of film and tv presentations of virtually all medical personnel (something the British tv series Green Wing got down to a comedic art), but also of those deemed insane as well – all in all, an interesting kind of symmetry.   On the surface, at least, there appears to be a limited repertoire of tropes and narrative plots upon which popular – and, it would also seem, scholarly – representations of the mad and mentally ill have relied.  I would be interested in hearing from others about other historical variations, especially those that were once prominent, but now have all but disappeared.


The History of Health Insurance and Mental Illness

The historical branches of German social insurance

The successful passage of health insurance reform legislation in the United States moves me to wonder about the extent to which scholars have looked into the role of health insurance in mental health care.  About ten years ago, a number of us historians examined the impact of mental illness on social insurance in Germany around the years 1880-1930.  Perhaps not surprisingly, the rise of shellshock in World War I and the killing of 200,000 psychiatric patients by the Nazis under their T-4 program provided the backdrop and inspiration for much of this research.   In my own study of disability within early German social insurance (Making Security Social), I found that providing health care benefits to those suffering from work-related nervous illnesses prompted a vocal, organized, and persistent backlash from those who contended that the system was only rewarding malingering.  The fact that some claimants contended that their nervous symptoms were caused, not by a factory accident, but rather by the torturous process of applying for a pension itself only seemed to confirm the view that social insurance and mental illness did not mix well.   In fact by the 1920s and 1930s, “pension neuroses” – as they were called – were publicly pilloried by conservatives, liberals, and the Nazis as emblematic of a social insurance system that bred whining and undermined productivity and masculinity.  Interestingly enough, however, the Nazis found it politically impossible to dismantle the social insurance system, despite the fact that many reformers in their party wished to do so.  So, there is certainly historical evidence indicating that, indeed, insurance systems do create new constituencies that provide powerful support for the system’s continuation.

So, I have some questions for others.  Are there good historical studies out there (articles or monographs) which examine insurance’s impact on mental illness and mental health and vice versa?  What role has health insurance played in reinforcing or undermining professional, institutional, and social trends and practices?  For instance, to what extent was social insurance responsible for the post-World War II boom in psychotherapeutic professionals and services?  What role have pharmaceutical companies played in health insurance systems affecting mental health across the globe?  What effects did health insurance schemes have on the process widely known as deinstitutionalization?  Please post any responses on the blog.


Interview: Eghigian on the History of Madness

As mentioned in an earlier post, Greg Eghigian has just published From Madness to Mental Health:  Psychiatric Disorder and its Treatment in Western Civilization (Rutgers University Press).  It is an edited collection of documents covering the history of madness and mental illness from ancient times to the present.  You can now hear a podcast interview with him about the book. Just click here

History of Bipolar Diagnosis in Children

National Public Radio has aired a story that examines the history of the increasing diagnosis of children with bipolar disorder in the United States.  The draft of the DSM-V that was just recently released attempts to mitigate against this trend with its proposal for a new diagnostic category: Temper Dysregulation Disorder.

You can access the NPR story at

United States v. Comstock

The U.S. Supreme Court heard arguments last month in the case of the United States v. Comstock.  The case involves establishing the limits of the state’s power to use civil commitment law to institutionalize sex offenders who have completed their criminal sentences.  While the case heard before the Supreme Court largely centers on the more or less technical matter of whether the federal government may usurp individual states’ rights in this regard, it has brought national media attention to a development that has been on the rise on both sides of the Atlantic – the use of commitment laws and/or psychiatric facilities to detain convicts, most without a readily apparent diagnosis.  Over the course of the 20th century, countries have adopted a variety of approaches to this issue:  the Institution for Psychopathic Criminals in Denmark, social-therapeutic facilities in the Federal Republic of Germany, and, more recently, long-stay facilities in the Netherlands.

Read the transcript of the Supreme Court hearing here:

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