Author Archive

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.

GE

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 http://www.npr.org/templates/story/story.php?storyId=123544191

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:  http://www.supremecourtus.gov/oral_arguments/argument_transcripts/08-1224.pdf

From Madness to Mental Health

Available beginning February 15, this anthology of primary sources chronicles the history of madness and psychiatry in western civilization, from ancient Israel to contemporary randomized clinical trials.  It also includes an updated bibliography of first-person narratives of mental illness compiled by Gail A. Hornstein. For more information click here.

To hear an interview with the author, click here.

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