Author Archive

Laqueur, “We Are All Victims Now”

The recent issue of The London Review of Books has a fascinating review by historian Thomas Laqueur (“We Are All Victims Now”) of The Empire of Trauma: An Inquiry into the Condition of Victimhood by Didier Fassin and Richard Rechtman (translated by Rachel Gomme).  Cutting a bit against the grain of accepted wisdom on the subject among historians of the human sciences, Laqueur concludes:

I take trauma as it is wielded even in these [various professional] communities to be largely epiphenomenal and strategic, and part of a larger story. The empire of trauma, the elevation or degradation of the term into a floating signifier, is the result of processes that we see at work elsewhere. Like so many others (‘tragedy’, ‘agony’), it is a word that has been translated from another realm and retains only wisps of its original meaning. Many more people are ‘passive aggressive’ than ever before; Bernard Madoff is a ‘sociopath’ not a ‘scoundrel’. This doesn’t matter very much; I don’t think that the drift of any of these words away from their narrower technical meanings into common usage makes much difference; I don’t think, and I am not sure Fassin and Rechtman do either, that the ubiquity of a word speaks to its efficacy, though they do seem to think that it testifies to the power of the newly constructed category.

More important, I don’t think they make the case that the category of trauma as it has been constructed in particular professional communities has in fact transformed reality, offered a language for victims to speak about historical wrongs and so on. I would suggest that the empire of trauma, in the sense of a universal acceptance that the suffering of others matters, that psychic wounds demand our attention, is part of a revolution that began in the 18th century, and whose moral dilemmas are still with us. ‘I do believe that in the end humanity will win,’ Goethe wrote in 1782. ‘I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everyone else’s humane nurse.’

The review is available here to subscribers.

Diagnostic Ambivalence and Psychiatric “Workarounds”

The Science, Knowledge and Technology section of the American Sociological Association has awarded this year’s Hacker Mullins Student Paper Award to Owen Whooley (NYU) for his paper “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders” (Sociology of Health & Illness, vol. 32, 2010: 452–469).


In 1980 the American Psychiatric Association (APA), faced with increased professional competition, revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric expertise was redefined along a biomedical model via a standardised nosology. While they were an integral part of capturing professional authority, the revisions demystified psychiatric expertise, leaving psychiatrists vulnerable to infringements upon their autonomy by institutions adopting the DSM literally. This research explores the tensions surrounding standardisation in psychiatry. Drawing on in-depth interviews with psychiatrists, I explore the ‘sociological ambivalence’ psychiatrists feel towards the DSM, which arises from the tension between the desire for autonomy in practice and the professional goal of legitimacy within the system of mental health professions. To carve a space for autonomy for their practice, psychiatrists develop ‘workarounds’ that undermine the DSM in practice. These workarounds include employing alternative diagnostic typologies, fudging the numbers (or codes) on official paperwork and negotiating diagnoses with patients. In creating opportunities for patient input and resistance to fixed diagnoses, the varied use of the DSM raises fundamental questions for psychiatrists about the role of the biomedical model of mental illness, especially its particular manifestation in the DSM.

New Collaboration with Psychiatric Times

The scholarly blog Psychiatric Times has invited H-Madness to share a monthly guest blog with their readers.  You can follow the monthly contribution here. (Note: You must first register with Psychiatric Times before you can have access to the series.  Registration, however, is free).  This month, Greg Eghigian discusses some of his thoughts on learning lessons from history.

Colloquium on the History of Psychiatry and Medicine (Harvard)

The Colloquium on the History of Psychiatry and Medicine offers an opportunity to clinicians, researchers, and historians interested in a historical perspective on their fields to discuss informally historical studies in progress.  Below you will find an announcement of this year’s unusually rich Colloquium (note meeting rooms for specific dates).  Please join us.

David G. Satin, M.D.


Department of Postgraduate and Continuing Education, McLean Hospital


Center for the History of Medicine, Francis A. Countway Library of Medicine



David G. Satin, M.D., DLFAPA Director

Open to students of history and those valuing a historical perspective on their professions.

———-Fall, 2010———-

September 16

“Anomalous Sensations and Astounding Disclosures’: Nineteenth-Century American Narratives of Asylum Experience”

Kathleen M. Brian:  Ph.D. Candidate in American Studies, The George Washington University

October 21

“Reforming Mental Health Via Hollywood:  ‘The Snake Pit’ (1948) and Its Audiences”

Benjamin Harris, Ph.D.: Professor of Psychology and Affiliate Professor of History, University of New Hampshire

November 18

“German-speaking Psychiatrist and Neurologist Émigrés to the U.S. After WWII”

Frank W. Stahnisch:  Associate Professor, AMF/Hannah Professorship in the History of Medicine & Health Care, Department of Community Health

Sciences and Department of History, University of Calgary, Member of the Hotchkiss Brain Institute

December 16

“Asylum:  Inside the Closed World of State Mental Hospitals”

Chris Payne

4:00 P.M.—5:30 P.M.

Minot Room, fifth floor, Countway Library of Medicine

Harvard Medical Area

For further information contact David G. Satin, M.D., Colloquium Director, phone/fax 617-332-0032, e-mail

On the Lighter Side: Darth Vader’s Diagnosis

Both the British Psychological Society’s Research Digest Blog and The Guardian feature a story on Eric Bui and his colleagues at Toulouse University Hospital in France.  They have written an article arguing that the Star Wars character Darth Vader most likely meets the diagnostic criteria for borderline personality disorder.  Bui and his colleagues see such arm-chair diagnosis as a way of teaching young people about the disorder and, in turn, helping to undermine the stigma associated with it.

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?

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