Archive for the ‘ How I Became a Historian of Psychiatry ’ Category

How I Became a Historian of Psychiatry: George Makari

We are delighted to present an interview with George Makari, M.D., as part of our “How I Became a Historian of Psychiatry” series. Dr. Makari is a historian, psychiatrist and psychoanalyst, serves as Director of The DeWitt Wallace Institute of Psychiatry and the Oskar Diethelm Library at Weill Cornell Medical College, where he is also a Professor, and is the author of Revolution in Mind: The Creation of Psychoanalysis (NY: Harper Collins, 2008). He has kindly agreed to share with us his intellectual trajectory.  

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How did your interest in the history of psychiatry develop?

I would say fortuitously. The origins of something like that, for me at least, started out in a much more general kind of interest. I came from a family of doctors and it was always assumed that I would become a doctor too; I actually got into medical school out of high school, so there was a road paved in front of me. However, when I was doing my undergraduate studies I became very interested in history, literary studies and writing. Part of the challenge then was to integrate these two interests. After my undergraduate education, I spent a year as a newspaper book reviewer and did some volunteer work in a child psychiatry department. I was trying to discover how I might  combine these things that I felt very committed to, which were writing and helping others, trying to be someone who had that kind of direct impact on people. It was also a time when Foucault was extremely influential, and Janet Malcolm wrote In the Freud Archives. It became increasingly exciting for me to imagine that I could integrate my interests by writing and being a psychiatrist. That writing eventually took the form of history.

The second thing I should mention was the importance of my intellectual community. You can have all these ideas about what you might be or do, but it’s very important to have a community that in some ways supports those inklings and helps them develop. As a medical student, I came to Payne Whitney (Cornell), where there was this extraordinary division that studied the history of psychiatry and was interdisciplinary – there were a lot of doctors and there were a lot of historians and these people were doing very exciting work. So that made it all seem very natural that I could do those things too.

At which point did you think, “I’m going to write a book”?

Well, that I’m afraid is a long story too! I started a project that was much narrower and much more defined, which was a history of transference theory and its relationship to German philosophy and medicine. I saw the potential for something really interesting about how this theory came from interesting currents in European philosophy and culture. And the pre-existing literature claimed the theory was de novo, came from Freud’s originality alone. So I took that project one step at a time and first researched the earliest use of transference as a notion in Freud. And then I moved on to the next one: I wrote a series of papers. Eventually, I thought, at the end of the day I’ll string all these papers together and I’ll have a monograph on the history of transference theory.

But a funny thing happened on the way. I had gotten a grant from the International Psychoanalytical Association and that really helped me do a lot more archival work in Europe. I ended up coming home with tons of new information from archives —all sorts of things that seemed important. So I tried stick these newer discoveries into that smaller project. I stuffed all of this good material into a book proposal that I prepared on transference. If anyone reading this interview is in the process of writing a book proposal, I suggest that you get the smartest person you can find to rake you over the coals before you write the book. That’s what I did, and again this has to do with having a generative community here at the Institute.

This discussion about my book proposal went badly, and it ended up being about how there were really two books in my proposal: one about transference and another about much broader issues in the history of the field. Feeling defensive, I argued that if someone else had written a book on the origins and development of psychoanalysis as a field in Europe, I wouldn’t have to put all that stuff in there, I could just refer to that work. But, I blurted out, in fact no one had written such a book. When I said that—when I heard myself say that—I was a bit taken aback. It seemed like that couldn’t possibly be true. But the more I thought about it, I was dismayed to recognize that it was true. No serious book had been written about the creation, consolidation, crisis and reworking of psychoanalysis before the collapse of Europe. And at that moment—actually it wasn’t a moment, it was a couple of very uncomfortable weeks, I transformed the book I had long planned into the one I now would write.

It was an organic process that involved knowing exactly where one wants to go, getting lost in archives and research, and then rediscovering a way that is more dictated by the materials and the opportunities they offered.

Once the book came out, did you find that its reception differed amongst the two communities (physicians and historians)?

They definitely have different approaches to it. I’m a bit spoiled because the reception has been extremely positive on both sides. But different people were interested in different aspects of the book. I think historians of medicine and historians of modern European culture responded to the way that intellectual history was integrated into social and political history; to the way I employed notions of discursive communities to link those two things and not have theories and concepts kind of floating out in space. Since much of historical discipline tends toward social history, they appreciated that integration.

I think the physicians, the psychiatrists, and especially the psychoanalysts who care so deeply about their history, appreciated how rich this restored tapestry was; in a way, they knew a very threadbare version of their own past. And I think they responded to the book in relationship to the contemporary struggles within psychoanalysis. Some at least felt that this account held important lessons about how truth claims are made, how they’re verified, how they’re not verified in psychoanalysis; they saw this – as opposed to standard great man biographies – as an attempt to understand the psychoanalytic community—what led to schisms, what’s led to the orthodoxy, the kinds of struggles and turbulence that community has had and still has.

On your side, how has this awareness of the history of psychiatry influenced the way in which you treat patients, and vice versa, how does being a psychiatrist affect the way in which you practice history?

It’s complicated because on the one hand, the obvious answer would be that studying history relativizes your view of any particular truth claim from the present. And that’s in fact partially so.  Historical mindedness does make me think differently about diagnostic categories, about claims for different novel advances. Right now, for example, it makes you turn a cold eye toward a lot of the claims that are coming from neuroscience and the psychopharmaceutical industry. It allows you to at times adopt an Olympian view, which can be very helpful. But the problem with that is that patients are coming to me for help. So I have to be committed to something; I have to be engaged in a way that will be helpful. You can’t sit there and philosophize about what this category error means about our culture. So in a way it forces you to take a stand, even in a situation where you have only a limited level of certainty, about how to benefit and console patients of different sorts. In that sense I think it’s been a really interesting process, but not an obvious one at all.

In terms of how being a psychiatrist affects my being an historian, that’s a touchy question, because what I’m very much not is a psycho-historian. Given the excesses of psychoanalyzing the history of psychoanalysis, I took great pains to not speculate about the inner states and inner motivations of the players in the book [Revolution in Mind]. At the same time, I would be a liar if I didn’t say that my experience studying character and human behaviour aren’t all over that book. When anyone tries to deeply understand a historical character, reading letters or diaries, going through their choices, you need to somehow pull together a sense of who they were. For example, sometimes there’ll be these telling moments, ones that literature uses to great affect. Flaubert was a genius at this. I think about those kinds of things every day, for seven or eight hours a day. So I am sure that process does not stop when I think about historical characters and how they negotiate their internal and external worlds.

Many thanks to Dr. Makari for this fascinating interview!

“How I Became a Historian of Psychiatry”: Cathy Coleborne

To start off the new academic year, Catharine Coleborne, Associate Professor at the University of Waikato (NZ) and author among others of ‘Madness’ in the family: Insanity and institutions in the Australasian colonial world 1860s-1914 (2010) and Reading ‘Madness’: Gender and difference in the colonial asylum in Victoria, Australia, 1848-1880s (2007) has kindly agreed to share with us how she became a historian of psychiatry:

Born in 1967 in Armidale in northern New South Wales, Australia, I grew up a long way from there in the Latrobe Valley area of Gippsland in the state of Victoria. This is still a working-class area of the state and I was always aware of the importance of socio-economic dimensions of the world at large. My left-leaning parents talked a good deal about politics, and my mother in particular instilled in me a strong sense of social justice. It was in my third year of studying History and English at the University of Melbourne that I began to see History as my chosen field. In that year, I undertook what might have seemed a fairly narrow focus across the two disciplines, and studied the history and literature of early-modern England. In my combined Honours year I wrote a History Honours thesis about widowhood from 1580 to 1680, and proceeded in my Masters thesis in History to examine health, illness and life stages for women in the context of feminist debates about their construction.  In doing this I gained a new awareness of the potential of social history by looking at people’s private lives, their family worlds, secrets, silences, repression, concepts of class and power, gender, and more. At the University of Melbourne, the History and Philosophy of Science department was yet to appoint historians of the calibre of Warwick Anderson to begin what has become an important research and teaching unit in medical humanities (now the Centre for Health and Society). I had discovered the interesting and influential work of Patricia Crawford and others, but I was still on the cusp of an intellectual journey that would lead me to define myself, eventually, as a cultural historian of medicine and psychiatry.

First, then, I was trained as a feminist historian: New Zealand Feminist historian Pat Grimshaw ran the History Honours seminar in Feminist History, where I read all the major Anglo-American feminist historians, and she was also one of the supervisors, together with Charles Zika, of my Masters thesis. Now, all of this provided me with a set of tools and ideas – but what did it mean to research British histories from Australia? I certainly did not visit any ‘real’ archives or get my hands covered by literal or metaphoric manuscript ‘dust’. My many primary sources for the Masters thesis – some forty-five diaries, medical advice books, sermons, treatises, and midwives’ books – were all found in major Microfilm collections or were published and available in the extensive Baillieu Library collection. Indeed, since I had not studied much nineteenth-century colonial Australian histories, unlike most of my peers, I missed the annual trip to the Public Records Office of Victoria which was then located out in the Western suburbs of Melbourne. In fact, I missed out on any hands-on archival experience – something of a rite of passage for historians, as Carolyn Steedman notes – until I made a shift to colonial histories. This notion of the ‘rite of passage’ through archival research might be interpreted as a ‘stubborn’ professional self-presentation by historians, but it also might represent an opportunity for historians to come face-to -face with theories of making history.

In those years, aside from a kind of personal awakening that – in my view – we ought to write histories of our own places, this shift came about because I worked as a research assistant for several Australian history projects in the early 1990s. One of these roles involved researching a history of nursing in colonial Victoria, a job which took me to small hospitals all round regional Victoria. I was often the first person for many years to request to see and read old hospital board minute books for the nineteenth century. I would be led into a cold, basement room and given the freedom to range over boxes of notes, scribbles, annual reports, photocopies and other materials. These were archives, but not always well cared for or catalogued. But my experience of making sense of these to craft history – to tell stories – was somehow captivating. I was hooked. I thought about a topic for doctoral study, enrolled at Latrobe University with my supervisor Diane Kirkby, now Professor and a prominent figure in Law and History circles, and finally visited the Public Records Office.

One of the seventeenth-century women I’d written about, Hannah Allen, had experienced mental breakdown. Widowed at 25, Hannah plunged into a ‘deep melancholy’. Her memoir, Satan his Methods and Malice Baffled, published in 1683, was an account of her depression through stories of temptation, terrors, suicide attempts, self-starvation and finally, recovery. Satan taunted her with apparitions, strange lights, and forced her to blaspheme: ‘I would write in several places on the walls with the point of my sizer, Woe, Woe, Woe and alas to all Eternity’. She ingested opium, smoked spiders in a pipe with tobacco, and tried to bleed herself to death. Hannah’s message is ultimately conservative, because she recovered her health with the help of both religion and marriage; this also explains the publication of her work. My reading of Michael Macdonald’s work about ‘mystical healing’ was important here, and as I explored colonial hospitals I was reminded of this theme: if there were sick bodies in colonial Victoria, there were bound to be sick minds. I duly investigated the archival possibilities for a study of lunacy in Victoria, and also found that little academic or scholarly work had been completed for that context. The archival record, in the form of extant institutional clinical patient cases, was plentiful, and nobody had made much of these sources, at least, not for this particular site. Studies of institutional confinement existed – most importantly, Stephen Garton’s landmark and influential text Medicine and Madness, about insanity in New South Wales between 1880 and 1940, and Jill Mathews’ important work Good and Mad Women which used twentieth-century records for South Australia – but Victoria’s history of mental illness and its institutions was less well known.

One of the things I recall most about that period of my academic life is that I was now facing a range of new intellectual challenges. One person remarked, ‘Congratulations on finding your archive!’ I will always remember this comment. It made me realize that the process of embarking on archival research in one’s own context might be somehow fraught or contested.  Was this archive of asylum records mine? Was it therefore the case that no one else might look into this archive? I was in new territory. I also now had to navigate the issues of archival record selection. Among the specific methodological or theoretical tools at my disposal, along with social history modes, were feminist methods which at that time emphasised female visibility and new practices of reading and interpretation; increasingly, too, and appropriately, like their interdisciplinary colleagues, historians had begun to assert new modes of interpreting gender as a relational category. In addition, the feminist historical debate was shifting and now moving towards more complex accounts of the way that gender, class and ethnicity all intersect. Embarking on doctoral work not only moved me out of one time period and into another, but it brought new and direct intellectual challenges. In other words, far from being somehow transported into a world of the past through ‘the archive’, I was forced into a difficult set of present theoretical engagements. In becoming an archival historian, I did not contract what the French philosopher Jacques Derrida termed ‘Archive fever proper’, but rather, I maintained a surly distance from the archive as I sought to make sense of how to use it.

My book Reading ‘Madness’: Gender and difference in the colonial asylum in Victoria, Australia, 1848-1880s (API Network, Perth WA: 2007) came out a long time after the end of my doctorate in 1998, and reflects my much earlier interests in constructions of female madness in the colonial setting.  The book also directly thinks about patient casenotes as texts which created ‘madness’ and which could be read as textual representations. The book also reflects my then perhaps naive conceptions of power through a Foucauldian perspective. I was mostly influenced then by Discipline and Punish, rather than Foucault’s other work, and saw the institution as carceral and productive of meanings about insanity and the insane, rather than as institutions which were actively negotiated and which were in dialogue with families of the mentally ill. While this work reflects my thinking at that time, it made me aware of the international field of the social and cultural histories of medicine. It led to a range of exciting opportunities: I curated an exhibition about the history of mental health in Victoria that was exhibited at the Medical Museum, part of the Brownless Medical Library at the University of Melbourne, in 1999. I later conducted new research into museum collections of psychiatric objects in Western Australia, Victoria and New Zealand and Dolly MacKinnon and I recently published the collection of essays Exhibiting Madness (Routledge, 2011) which examines these themes of insanity and the museum and the politics of exhibiting collections of psychiatric objects, among many other topics.

I first came across the phrase the ‘asylum archive’ in the work of my friend and research colleague Jim Mills in his powerful account of race and insanity in colonial India. This term was used with some irony, since Mills found his major archival sources for a study of ‘native-only’ asylums in south India rotting in a cupboard in a disused psychiatric institution: nobody even knew they were there, yet the records contained hundreds of cases of Indian people confined by British administrators for wandering, smoking cannabis, and other behaviours which led to their diagnosis of insanity. Writing about South Africa, Sally Swartz laments the lost lives of women psychiatric patients at various institutions in the Cape. These lives are lost, writes Swartz, despite the vast amount of record-keeping about them.

It is something of a paradox that we know such a large amount about institutionalised people when they were hidden from public view in their own lifetimes. Archival records of insanity contain histories of people who would otherwise have remained virtually invisible, though those lives were heavily circumscribed. Recently, my own work has drawn specific attention to this asylum archive. Following my doctoral work which had focused on more limited ways on the negotiations of the inane and their families with institutions, I was interested to find out how families interacted with mental hospitals in the nineteenth century, and how those interactions, too, were gendered. This research involved new approaches to four different state or national archives and culminated in the book ‘Madness’ in the family: Insanity and institutions in the Australasian colonial world 1860s-1914 (Palgrave, 2010). I see this as an important contribution to social and cultural histories of insanity, institutions and families, as well as to discussions about archival sources, finding emotions in the archive, and the patterns of institutional treatment of the insane in the colonial world.

As part of my new research into ethnicity, migration and insanity, part of a larger study with Professor Angela McCarthy at the University of Otago, I am currently immersed in a large dataset of archival cases from one psychiatric institution, looking for hidden and open references to ethnicity, gender and class, building on the rich scholarship of American historians of earlier decades, including Gerald Grob, who examined questions of inequality and the treatment of the insane. Together McCarthy and I produced the edited collection Migration, Ethnicity, and Mental Health: International Perspectives, 1840-2010 (Routledge, 2012). Those constant themes of power, social and cultural difference, and how both the institution and the archive reflect and produce such ‘identities’, continue to fascinate me. Mental health and illness, and the institutions used to confine and treat the mentally ill, provide a way for historians to encounter the disenfranchised peoples of the past. Even more powerfully, by engaging as historians with present debates about deinstitutionalisation and community care, and by becoming involved in writing and producing histories of twentieth-century mental health care, historians can actively interrogate the power structures of the past and their enduring legacies in the present. Increasingly, through community projects and engagements, I am moving towards a deeper awareness of the role and function of psychiatric history in our current moment.

Many thanks to Cathy for sharing with us her intellectual trajectory!

How I Became a Historian of Psychiatry: Gerald Grob

To continue our intellectual biography series, Gerald Grob, the Henry E. Sigerist Professor of the History of Medicine (Emeritus) at Rutgers University and author of various books including The State and the Mentally Ill (1965), From Asylum to Community: Mental Health Policy in Modern America  (1991) andThe Deadly Truth: A History of Disease in America (2002), has kindly agreed to share with us his own trajectory:

Like many American historians, I shared the social democratic ethos that dominated the discipline in the post-World War II decades. I was born in 1931 at the beginning of the Great Depression. My parents were Jews who had migrated from Poland to the United States in order to escape from an environment in which anti-Semitism was endemic and virulent. Married in 1929, they lacked formal education and struggled economically for most of their lives. Yet they instilled in my sister and me an almost naive faith in the redemptive authority of education quite apart from its role in enhancing career opportunities. Their Judaism, poverty, and liberal outlook made then staunch supporters of Franklin Delano Roosevelt’s New Deal.

 

My commitment to the social democratic left was further strengthened during my years at the City College of New York, a bastion of liberal if not radical thinking. The student body included many committed to Marxian ideals, which in their eyes provided an alternative to what appeared to be a rapacious capitalism. Although I was not unsympathetic to campus Marxists, their single-mindedness and hostility to alternative ideas proved unacceptable, and my allegiance remained with the liberal and social democratic left.

 

My faith in a liberal political ideology and its promise of progress, nevertheless, was always tempered by a recognition that human beings were neither completely rational nor moral. Too young to serve in World War II, I was increasingly aware of the horrors of Nazism and the Holocaust. With but a single exception, all of the members of our family who had remained behind in Poland–including my grandfather–were murdered by the Germans. The Holocaust left me with an abiding sense of tragedy and a recognition of human frailty. My approach to history, therefore, reflected contradictory tendencies: a commitment to social democratic principles; a belief in the fallibility of human nature; a faith in the ability of individuals to make genuine choices independent of the forces operating upon them; and hostility to any overarching historical explanations bordering on determinism. Nor was I persuaded that all phenomena were linked or that it was possible to apply all-encompassing theories to human behavior and society.

 

After graduating from City College in 1951, I briefly attended Columbia University, where I received my M.A. in 1952. Through a circuitous route I ended up at Northwestern University and received my Ph.D. in 1958 (interrupted by two years of military service in the army). My dissertation (published in 1961 and entitled Workers and Utopia) dealt with the late nineteenth-century American labor movement, a subject that had interested since my undergraduate days.

 

In 1957 I accepted a teaching position at Clark University in Worcester, Massachusetts. At that time Clark was a small institution but one with a rich intellectual tradition. With a total faculty of no more than about seventy, friendships transcended disciplinary lines. In 1959 a colleague in psychology with extraordinarily broad interests suggested that I set a graduate student to work on a history of an old state mental hospital in Worcester. Upon familiarizing myself with the hospital, I found that it had played a significant role in the history of the care and treatment of persons with severe mental illnesses. I also found that a large mass of manuscript material had survived, including every single patient case history since its opening in 1833 (which by the 1960s exceeded 70,000). By this time I had decided not to pursue my research in labor history, and therefore undertook the task of writing a history of Worcester State Hospital since its opening in 1833.

In retrospect, my decision to pursue research on the history of psychiatry and institutional care was somewhat presumptuous. My knowledge of psychiatry was nonexistent. At the outset I pursued two strategies. The first was to begin a systematic reading of psychiatric works. Secondly, I attended basic training sessions offered to interns at the hospital in order to familiarize myself with clinical practice and institutional life. My book The State and the Mentally Ill: A History of Worcester State Hospital in Massachusetts 1830-1920 was published in 1966. I found that the project presented formidable problems. I was determined not to write a purely local history, but to place the evolution of the hospital within the framework of public policy. My overarching concern, therefore, was with historical context and the ways in which seemingly disparate elements interacted.

The State and the Mentally Ill, though a narrow study, shaped virtually all of my subsequent thinking about the history of institutions and psychiatry. Having learned much from the research on the Worcester hospital, I decided to undertake a national history. Originally I had intended to write a one volume study. Given the sources, this proved impossible, and I ended up by writing a multi-volume study. The first volume (Mental Institutions in America: Social Policy to 1875) appeared in 1973; the second (Mental Illness and American Society 1875-1940) in 1983; the third (From Asylum to Community: Mental Health Policy in Modern America) in 1991. I published a summary volume (The Mad in America: A History of Their Care and Treatment) in 1994. Subsequently I collaborated with Howard H. Goldman in publishing in 2006 The Dilemma of Federal Mental Health Policy: Radical Reform or Incremental Change,? a volume that brought much of the history to the present.

My emphasis has always been on those elements that shaped and modified mental health policy: the changing composition of the population with severe mental; concepts of the etiology and nature of mental illnesses; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, social, and professional attitudes and values. Equally significant, I have tried to show how the structure of the American political system shaped the mental health system.

After working on the history of psychiatry for nearly four decades, my interest began to shift to the history of changing disease patterns. For many years I taught a course on the changing epidemiology of disease. I decided therefore to shift my focus to write about this subject. The result was the publication in 2002 of The Deadly Truth: A History of Disease in America, and in 2010 (with the collaboration of Allan V. Horowitz) Diagnosis, Therapy and Evidence: Conundrums in Modern American Medicine. In these books I hoped to illuminate changing patterns of morbidity and mortality and to reveal the folly of those who suggest that the elimination of disease should be the primary goal of medical science.

In closing I must concede that a series of personal beliefs have clearly shaped my scholarly work. I have never held to the modern belief that human beings mold and control their world in predetermined and predictable ways. This is not in any way to suggest that we are totally powerless to control our destiny. It is only to insist upon both our fallibility and our inability to predict all of the consequences that follow our actions. Nor do I believe that human behavior can be reduced to a set of deterministic or quasi-deterministic laws or generalizations, or that solutions are readily available for all our problems. Tragedy is a recurring theme in human history and defines the parameters of our existence. I have always tried, therefore, to deal sympathetically with our predecessors who grappled–so often in partial and unsuccessful ways as we still do ourselves–with their own distinct problem.

Many thanks to Gerry Grob for sharing this story with us!

How I became a historian of psychiatry: Edward Shorter

For the second installment of the “How I became a historian of psychiatry” series, Edward Shorter, Hannah Professor in the History of Medicine and Professor of Psychiatry at the University of Toronto, author among others of A History of Psychiatry from the Era of the Asylum to the Age of Prozac (1997) and From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (1992), kindly shares his intellectual biography with the H-Madness community:

This story began in 1967 when, a fresh young history PhD graduate, I came to the University of Toronto.  I had been trained as a social historian and after several projects far away from the history of medicine, in 1975 I wrote a general history of the family, not that it was such a medical contribution – but it called my attention to a number of medical issues in the lives of women historically:  infected abortion, weariness from overwork, and iron-deficiency anemia.  This led to a history of women’s health care (Women’s Bodies) in 1982.  This was full-blast medical history, but researching it made me aware that I knew almost nothing of medicine.  So I went to medical school for two years, taking all the basic medical sciences.

I now felt better equipped to take on a big problem: the history of psychosomatic illness, especially “hysteria,” mainly in women, over the centuries.  Knowing something about medicine was helpful here because of the difficulty in sorting out symptoms that are psychogenic (“hysteria”) from those that are organic-medical, such as endometriosis, often dubbed “hysterical” in the past.  This research resulted in From Paralysis to Fatigue (1992).

I was now thoroughly enmeshed in psychiatry, and went on to write a general history of the discipline, which appeared in 1997 and was read by a number of psychiatrists.  I became friendly with several whose work I greatly admired, and who subsequently influenced the direction of my own studies, in particular David Healy, Max Fink, Bernard Carroll, Tom Ban, Tom Bolwig, and Gordon Parker.  Animated email exchanges with this group produced a sharp research interest on my part in two themes: the history of diagnosis (nosology), and the history of psychiatric medications (psychopharmacology).  This led to a string of publications: A History of Shock Therapy, with David Healy (2007), Before Prozac (2009), and Endocrine Psychiatry; Solving the Riddle of Melancholia (with Max Fink) in 2010.  My latest book, The Rise and Fall of the Nervous Breakdown – And How Everyone Became Depressed, will be published by Oxford early in 2013.  I should say that among contemporary historians of psychiatry there are also several whose work I have learned from, in particular Patrizia Guarnieri and Ian Dowbiggin.  Everyone in our field learned from Roy Porter.

There are two points of more general interest in this cascade of self-esteem: (1) Historians of psychiatry have a real contribution to make to clinical psychiatric diagnosis, subject as it is to the buffeting of fashion and fad; that contribution lies in surveying the enormous historical experience of psychiatry to see which diagnoses seem to correspond most closely to natural disease entities.  (2) Psychiatric historians also have a contribution to make to therapeutics, because many past therapies have been discarded not because they were unsafe or ineffective, but because the patents expired!  Or because (as in the case of electroconvulsive therapy) society turned against them for non-scientific reasons.  Or because, as in the case of the barbiturates, makers of newer drug classes scorned them in advertising as old-fashioned and risky.

Among my current interests are pediatric catatonia and self-injury behavior in autism, and the extent to which they have been relieved in the past with ECT; the early “tranquilizers” and sedatives, discarded as effective treatments largely because of psychiatric urban myths of various kinds; and melancholia as a distinctive illness in its own right with characteristic biological markers.  I find this research tremendously exciting, and hope that historian colleagues will become involved. 

Many thanks, Edward Shorter, for sharing this story!

New H-Madness series – “How I became a historian of psychiatry”: Hans Pols

In the spirit of reminding ourselves and others why our field is so fascinating, H-Madness is launching a new series entitled “How I became a historian of psychiatry“. Since this is such a unique and inter-disciplinary field, we thought it would be fun to find out how various scholars (often accidentally) landed into this career path.

To launch the series, Hans Pols, Associate Professor in the Unit for the History and Philosophy of Science at the University of Sydney and H-Madness editor, shares with us his own intellectual biography:

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.

Hans Pols

Unit for History and Philosophy of Science

University of Sydney

Many thanks to Hans for sharing his experience with us. More to come soon!

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