Author Archive

Syllabus: Crozier, “The History of Psychiatry”

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Ivan Crozier is a Senior Lecturer at the Science Studies Unit at the University of Edinburgh.  He is the editor of a number of books: Body Parts: Critical Explorations in Corporeality, with Christopher Forth (2005); a edition of Ellis and Symonds’ Sexual Inversion, with a 86 page introduction (2008); The Cultural History of the Body vol 6, 1920-present, on which he wrote about the sexual body (2010); The Cultural History of Sexuality vol 5, 1820-1920, with Chiara Beccalossi (2010).  He has published a number of essays on the history of psychiatry in journals such as Medical History, History of Psychiatry, Social History of Medicine, and Journal of the History of Medicine and Allied Sciences.  He is currently writing a history of the culture-bound syndrome koro from 1890s to the present, and a study of the important criminal responsibility trial of Ronald True, from 1922 (under contract with Palgrave).

This course is not an overview of the development of psychiatry; rather it aims to teach graduate students how to read psychiatric discourses (usually in the form of journal articles), by asking questions about how the object being written about is constructed, who the document is written for, how it relates to other documents in the field, how evidence is used, where the patient is in the discourse, how experience is mediated through language, how diagnoses are constructed, etc. In order to get to these issues directly, a number of primary sources are set for close reading in the seminars, with some background information given both in the handbook (the lists of secondary sources) and in a short contextual presentation before the class ‘attacks’ the source. The class is taken by graduate students in the MSc in History andTheory of Psychology, and in the MSc in Science and Technology Studies.  Usually, I also have 4th year undergraduate medical students who are taking a special project with me in the history of psychiatry, a few psychiatrists (one in 2009 was a visiting psychiatrist from Ethiopia; one last year was a MD student in psychiatry), graduate students visiting me from overseas, and of course any of my PhD students who are working in history of psychiatry (of which there are several).  The topics addressed reflect my methodological interests (especially the last week on Hacking, Davidson, and Foucault, through which we reflect on the discourses that have been grappled with in the preceding weeks, but the approach used throughout the class derives from these perspectives as well as from the Sociology of Scientific Knowledge, which is also a core component of graduate work at the Science Studies Unit).  The psychiatric topics addressed give a few different topics that often relate to other work students are doing (so, for example, PhD students working on eating disorders, depression, criminal responsibility, etc. have a week that fits their broader research, and they often lead the discussions in those weeks).  They also relate directly to the areas on which I research (sexuality, culture-bound syndromes, colonial psychiatry, criminal responsibility).  I have found over the years (and I do this with my undergraduate course in the history of the human sciences too) that teaching closer to my research gives a lot more depth to the analysis, which I try to encourage.  As such, the course has a number of methodological, intellectual and historiographical agenda, rather than offering a narrative about the development of psychiatry as a field (which is of course offered in the secondary sources, as well as in the introductory lecture).  Each year I try to adapt the course to fit the topics of interest to the students who are taking it, utilising the same pedagogical standpoints outlined here.

New Yorker Magazine: A Case of Psychopathy in New Zealand

Colin Bouwer

New Yorker magazine this week has a piece by Carl Elliot (“Letter from New Zealand”) entitled “Mind Game.” It chronicles the remarkable story of a psychiatrist, Colin Bouwer, who was convicted of murder and is presently serving a life sentence.  You must subscribe to the magazine to read the full article.  Here is the abstract:

LETTER FROM NEW ZEALAND about a psychiatrist who killed his wife. Dunedin, New Zealand, is an uncommonly peaceful place, yet when it does have a murder, it’s spectacular. What is striking about the case of Colin Bouwer, a psychopathic psychiatrist who was once the head of psychiatry at the University of Otago Medical School and is now a convicted murderer, was the man’s ability to fool his colleagues, many of whom would have studied psychopaths in their medical training. In November of 1999, Dr. Andrew Bowers faced two mysteries. One had to do with Colin Bouwer’s ailing wife, Annette, who had been in good health until a few weeks earlier, when she began having peculiar symptoms. On the morning of November 20th, she slipped into a hypoglycemic coma although she didn’t have diabetes. The second mystery was Colin’s behavior. After a few days in the hospital, Annette was discharged; four days later, she went into another coma. After being discharged a second time, she began having symptoms of hypoglycemia again. Early on the morning of January 5, 2000, Colin called Bowers and told him Annette was dead. Bowers wanted to order a postmortem exam, but Bouwer objected. Bouwer was born in Bloemfontein, South Africa, in 1950. He met Annette at a meeting of Mensa, and they married in 1981. In early 1997, he immigrated to New Zealand; Annette and their two children soon followed. Bouwer quickly rose to the top administrative post at the University of Otago. He told his colleagues that he’d been involved in the South African resistance struggle and tortured. By all accounts, he was charming and an excellent psychiatrist. On September 15, 2000, nine months after Annette’s death, the Dunedin police arrested Bouwer and he was charged with murder. Bouwer had written false prescriptions for glucose-lowering drugs, ground them up with a mortar and pestle, and given them to Annette, most likely in her food. The day before she died, he picked up a false prescription for a thousand-unit vial of Humalog insulin—a dose large enough to kill her. Although Bouwer was indeed a qualified psychiatrist, much of his autobiography was constructed out of lies and half-truths. Bouwer had actually been trained as a doctor by the South African military. By the time the police completed their surveillance after Annette’s death, investigators believe that he was sexually involved with at least four hospital staff members in Invercargill and Dunedin. Bouwer’s behavior prior to the murder was stunningly reckless. What personality type does this kind of thing? In 1941, Hervey Cleckley published a book about psychopaths called “The Mask of Sanity,” which told the stories of charming and friendly men and women who had a kind of moral blindness. The fact that even clever psychopaths show such poor judgment about their own interests suggests a deeper neurological impairment, and at least some aspects of psychopathy appear to be genetically related. Mentions Colin Bouwer, Jr., who was arrested for killing his wife, Ria, in 1999. Colin Bouwer was given a life sentence in November, 2001, with a minimum of thirteen years; he appealed the decision, but his sentence was later increased to a minimum of fifteen.

New York Times: Anti-Psychotic Prescriptions for Pre-Schoolers

The New York Times has posted online a video essay on an increasingly well-documented trend in the United States: prescribing powerful psychotropic drugs to children as young as age 5.

Syllabus: Evans, “Madness and Melancholy”

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Gareth Evans has a Ph.D. in English and a Master’s in Library and Information Science from the University of Wisconsin-Milwaukee.  For some time now, he has been contemplating writing essays about The Bostonians, teaching “Bartleby, The Scrivener,” and the cultural and political significance of the fiction reprinted in the Voice of Industry, an American labor newspaper published in the 1840s. He is currently a Lecturer in the Hutton Honors College at Indiana University Bloomington, where, in addition to his class on Madness and Melancholy, he has taught classes on Henry James, Herman Melville, and 21st-Century American Fiction.

The syllabus for “Madness and Melancholy” is for a revised version of a class I taught four times during the 2009-2010 academic year. In its original version, the class was a sexed-up version of a Western Civilization class that spanned the period between ancient Greece and the Renaissance.  In addition to the readings from and about that period you see below, the class also included extracts from Cicero’s Tusculan Disputations and all of Erasmus’s Praise of Folly.  As it was initially taught, the class did what it was designed to do: fulfill the requirements of the first half of the modernized two class version of the Great Books program offered by the Hutton Honors College at Indiana University Bloomington (IUB); that is, focus solely on work written before and during the Renaissance.   Many students found the reading repetitive in its concerns, and given how little definitions of madness and melancholy change between ancient Greece and the Renaissance, they were correct to do so.  To add variety to the class, and to give students a sense—a sense many of them sorely lack—of how much experts on psychology and psychiatry disagree about how depression and other real or supposed mental disorders are diagnosed and treated, I have added a two-week section that focuses on: (1) contemporary debates about the Diagnostic and Statistical Manual of Mental Disorders (DSM IV); and (2) a recent discussion of an essay by Paul Andrews and Andy Thomson that reiterates age-old claims about the connection between depression and intellect, while also suggesting depression is “an evolved emotional response to complex problems, and its function is to promote changes in body systems that promote analysis of those problems” (http://sites.google.com/site/paulwandrewsphd/).

In its original version, the class worked well with students who excelled in the class.  And in the Honors College “excelled” means received an A. Such students excelled largely because they matched their ability to respond to Euripides and Shakespeare with their ability to understand, pick apart, and analyze the arguments made by Burton, Erasmus, Ficino, and Plato.  As that comment suggests, what separated, and is likely to continue to separate, the excellent from the good and the mediocre, is the ability to comprehend, engage with, and thoughtfully analyze the philosophers of madness and melancholy.  Students who excelled also did so because they were able to set aside the widespread contemporary assumption that mental disorders of all kinds are bred in the brain, passed down from generation to generation in the same way forms of cancer and heart disease seem to be. That assumption has been an issue in the class, and I attempt to address it with the contemporary material I have added to the syllabus.  I chose madness and melancholy as a topic in part because I wanted students to read material they had not read before.  What is more, even if they have read the material–and many of the students have already read Hamlet and King Lear–the nature of the course forces them to read and write about the material through the lens provided by the other work—work concerned with madness and melancholy, anger and folly—they have read during the class.  Some students coped well with the demands of the class last year, but others flounder because they are unable to cope with material that makes assumptions so alien to their own.  Once again, then, the material I’ve added to the class seeks to bridge that gap, make students engage with the significance of that gap, between what passes for common sense in contemporary American discussions of, say, depression, and what passed for common sense in ancient, medieval, and Renaissance reflections on melancholy.  What I want students to do is feign the impossible and think like an ancient Greek, a medieval Abbess, or a renaissance philosopher.  Whether the changes to the syllabus will enable more students to perform such a trick remains to be seen.

I’ll return to the reading for the class later, but now I am going to write a little about the writing workshops, the abstract presentations, and the visits to libraries that are part of “Madness and Melancholy” and of almost every class I teach.  The number, HON H-211, under which “Madness and Melancholy” is taught, is defined by the Hutton Honors College as a “writing intensive” course, which means that every student in the class must write at least twenty pages during the semester—a breathtaking amount to be sure.  In the version of the syllabus my students receive, I explain that I expect them to write analytical essays that support their claims by quoting and paraphrasing the work they are analyzing.  Before the first writing workshop, I also hand out, and discuss with, my students, a writing sample that contains all of the features I expect an essay to contain if I am to give it an A.  If they worked as they are intended to work—and how rarely they do—the writing workshops would help students learn how to write the kind of essay I want them to write. The workshops are peer response sessions in which students are divided into groups of three or four. Each student brings a copy of his/her essay for the other members of the group and then twice reads that aloud, before listening to the responses and suggestions made by the other students in the group. The workshops are, in addition to their primary intent, a way of getting students to make an early start on their essays, while they also point to the process by which writers revise their work in response to the suggestions of people who read it in draft form or listen to it as a conference presentation.  The five minute abstract I ask each student to present at the end of the semester is, again, partly an attempt to get students to make an early start on an essay, but it is also designed to get them to do what graduate students and faculty do every time they propose a conference paper: summarize their argument, explain how they will make that argument, and clarify the relationship of that argument to current arguments made about the topic they are addressing.

In addition to its emphasis on writing, the class seeks to promote information literacy through visits to the main university library and to the Lilly Library, which is the special collections library at Indiana University Bloomington. In their visit to the Lilly, students learn about the policies of the library and its collections as a whole are shown. During much of the class, however, they are able to look at and handle some of the primary sources for the course, including a First Folio of Shakespeare, and first editions or first English translations of material they read for the course.  In their visit to the main library, I show students how to search the university catalog, WorldCat, and a variety of subject specific databases. The class is accompanied by a ten-question exercise designed to enable students to demonstrate they know how to use and search the catalogs and databases they are shown during the class.  I only began to teach such classes after I got a Master’s in Library and Information Science.  It was only while I was getting that degree that I realized that I, like most of the current and former academics I knew, had taught themselves how to use a library.  That academics had been forced to teach themselves how to use a library struck me then, and now, as an unconsciously constructed barrier to student learning. By taking my students to the libraries, I try to make drown that barrier. It also seems to me particularly important now, in the day of rampant plagiarism and Wikipedia, that students be shown how to use and find reputable sources, the kind of sources that academics and students should routinely use when they work.

Since I demand clarity from my students, I will be honest and say that, last year, my description of “Madness and Melancholy” was not as clear as it needed to be.  Much of the material was new to me when I first taught the class, and it was only through teaching the class that I was able to clarify and describe all of its central concerns. My emphasis on context, however, has been clear from the start in the class description and in the opening reading from Padel and Watters, both of whom stress the centrality of context to the ways in which madness, melancholy, and contemporary American mental disorders are described, treated, and defined. That said, my current class description differs from its predecessor by making it clear: (1) that the class is far less concerned with psychology and psychiatry as they are currently defined than it is with questions of moral philosophy; (2) that students will learn as much, or more about ancient and Renaissance medicine as they do about contemporary science; (3) that for much of its history, doctors, philosophers, and playwrights were far less interested in genetics than they were with the humors, the planets, the gods and God; and (4) that much of the writing on madness and melancholy is far less focused on what it means to be well than on what it means to be “good.”  It is now clear, too, that “Madness and Melancholy” is not a class that uncritically endorses any of the ways—ancient, medieval, renaissance, or contemporary—madness or melancholy, depression or anger, mood disorders or social phobia have been viewed, treated, and defined.   Instead, the class description now makes it clear that debate and disagreement are at the heart of the class.

Colloquium on the History of Psychiatry and Medicine (McLean Hospital and Center for the History of Medicine)

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