Archive for the ‘ books ’ Category

Book Review – Jan Goldstein, Hysteria Complicated by Ecstasy: The Case of Nanette Leroux (Princeton University Press 2011)

Screen shot 2013-01-11 at 3.15.33 PMBy Michal Shapira

Jan Goldstein’s new book Hysteria Complicated by Ecstasy: The Case of Nanette Leroux is a compelling and intriguing demonstration of what can be gained by close study and analysis of one archival manuscript of a medical case history. The case in point tells the story of eighteen-year-old Nanette Leroux, a village girl from Savoy who fell ill in 1822 with diverse nervous symptoms (among them convulsions, lethargy, sleepwalking , and what her physicians called catalepsy, that is a muscular contraction that fixed her limbs and other body parts in their positions when the symptom took hold). Nanette’s doctors believed the girl to be suffering from “hysteria complicated by ecstasy” following repeated “frights” caused by a rural policeman said to have tried to “offend her modesty.” Goldstein discovered the lengthy (200 page) manuscript at the Institut de France in Paris, and she uses this archival find as a window into a wide-range of historical contexts and methodological questions. The book is divided into two parts which in themselves serve as an interesting model for a historical critical edition: the first half of the book is a meticulous exercise in micro-history providing context for and interpretation of the archival text, and the second half includes the translated and transcribed manuscript itself. Indeed, despite the manuscript’s obscurity, Goldstein is able to successfully “milk it for what it’s worth” and to demonstrate why it is noteworthy. Her ability to reveal and discuss early nineteenth century rural and small-town life in the Alpine region of Savoy and some of the medical debates and conceptualizations of the time is inspiring.

 

While the psychiatric case as a genre grew in length over the course of the nineteenth century, here we have a detailed, and therefore significant, archival example from early on in the century. Through the text, we learn about the patient herself. Described as a somewhat passive, simple village girl, she also had also her moments of wit, creative use of self-expression to assert some control over her situation, and even rebellion against medical practice. We also learn about her two French physicians, Alexandre Bertrand and Charles-Humbert-Antoine Despine, and their conflicting views as they produced the medical edition. The two men came from different backgrounds. Despine was a materially comfortable man of the provinces working for the medical administration of the state-run thermal baths at Aix-les-Bains.  Bertrand, on the other hand, was a young and struggling Parisian but a scientist of the big city. What brought these two physicians together was their mutual interest in animal magnetism and Despine’s search for a worldly colleague to help him in the writing of the case. Their relationship allows Goldstein to explore the production of science in the provinces and ties with metropolitan expertise. Despine first meets Nanette after she had already been examined by a local physician and was also helped by a supportive layman. Despine’s advice was that she should be bought to Aix-les-Bains for therapies such as baths, showers, and electro-magnetism. He approached her both as a doctor trying to cure her and as a scientist aiming to experiment with the case in order to produce scientific knowledge.

 

True to her goal of getting as much as possible out of the text, Goldstein uses this micro-history to artfully explore larger macro-historical trends. Indeed her thorough approach leads her to wonder when the historian needs to stop contextualizing or when is ever “enough context.” Her method is an exhaustive one. Like a true detective, she restores the different backgrounds to the manuscript, from the immediate textual contexts of the scientific debates at the time to the larger social, cultural, political, and economic circumstances in which Nanette, her doctors, and others mentioned throughout the case lived. The result is dazzling, demonstrating how with imaginative scholarly work a broader picture can be pieced together. For example, Goldstein offers fascinating facts about the Savoy region itself under the Old Regime, the Revolution and the Piedmontese restoration. She also reveals the spa at Aix-les-Bains as an interesting and unique setting where urbane, cosmopolitan, tourist crowds meet the provincial misfortunate in a new age of travel and consumerism.

 

The context Goldstein provides is so rich that at times it seems that she drifts too far away from the medical case itself. Yet, again and again she is able to demonstrate how seeing the whole setting is important to understanding the particular episode. For instance, she shows how the tension between the traditional ways of Nanette’s native life and the burgeoning modernity and consumer market culture that the girl experienced in the spa town in fact played out in her illness. Without studying the rich background of place and time, Goldstein argues, the case’s details would have remained unclear. For historians of science and medicine, the scientific debates of the time and the different diagnostic labels of catalepsy, hysteria, and ecstasy assigned to the case are of special interest. Goldstein points out that the concept of hysteria emerged in the 1820 but that at the time it was not necessarily a uterine malady and could still be considered gender-neutral and devoid of erotic connotations. She also reveals the complex and conflicting gender dynamics at the time both between Nannette and her caretakers and impressively also inside Despine’s household.

 

But beyond contextualizing the manuscript, Goldstein is also interested in analyzing and making sense of the case. It is here that the more theoretical and methodological questions of the book emerge. A key issue is trying to answer how contemporaries conceptualized Nanette’s illness. While for post-Freudian twenty-first century readers of the text it might seem as if Nanette is suffering from sexual trauma due to the assault of the policeman, Goldstein emphasizes how the concept of psychological trauma was not yet available to contemporaries, as it would only develop from the 1870s onwards. What the participants in the manuscript did believe was that Nanette’s experience of fright served as a trigger to her illness. This early nineteenth century belief, Goldstein insists, was manifested in a manner that was utterly different than in the fin de siècle. Nanette’s doctors, for example, were not interested in a more all-embracing psychological explanation of her illness as key to self-understanding, or in memory-recovery of the violent episodes. They only aimed to eradicate her symptoms and restore her health and to find out whether animal magnetism could accomplish such goals. While the two doctors shared interest in magnetism, they favored different explanations for it. Despine subscribed to the late 18th century tradition of Mesmer, believing that the cure is of a physicalist nature, while Bertrand preferred a mentalist view of magnetism, and at times was willing to look at the illness from a psychological point of view, seeing it as stemming from Nanette’s “ideas” or “imagination.”

 

Goldstein takes her work a step further when she proposes a twenty-first-century interpretation of the case, using both Michel Foucault and Sigmund Freud to reread it in a more theoretical fashion. She defends this approach in an appendix that one wishes was more developed, especially given the theoretical tensions between these two writers. Her rationale for advancing in such a direction is that Nanette’s physicians shared certain limitations in understanding her illness that Goldstein believes invite the historian to try to improve on their work. In trying to explain why the two doctors ignored the sexual elements in the case—so obvious to a twentieth-first century reader— Goldstein uses Foucault to claim that Despine and Bertrand lived in a transitional moment in the early nineteenth century, just on the threshold of “sexuality” as it was later understood. For them, sexuality was not yet turned into an object of scientific knowledge

and was not yet part of a causal scientific explanation of a wide array of human behaviors. Despine and Bertrand functioned in the era “before sexuality” as they did not automatically connect their patient’s pathology to sex and did not locate sex at the center of her being and of her illness. Their sensitivity to sexual matters was different than ours and their concept of hysteria therefore was not so closely tied to sexuality. Hence they saw no point in analyzing in depth what seemed to be attempted rape.

 

Goldstein then uses a Freudian approach to try to conceptualize Nanette’s own subjective understanding of her situation and the causes of her illness. In a sense here Goldstein brings the case “back to sexuality” – a reverse move from the Foucauldian reading she utilizes thus far and one that could have been elaborated upon further. Goldstein is guided by the psychoanalytic assumption that Nanette possessed an unconscious mind that enabled her to manipulate cultural symbols and discursive possibilities available to her for her own means. In this manner, for Goldstein, the fact that Nannette demanded a watch of her own “surely speaks of her wish—probably unconscious and hence articulated symbolically through the medium of symptom—for some freedom from society’s relentless demands on her biological performance [as a woman], some measure of self-regulation.” (p. 118) Such a hypothesis may not appeal to all historians and may raise the question of whether it is the role of the historian to explain the described illness by twentieth-first century standards. Yet such creative reading does enable a certain interesting interpretation of the case, according to which Nanette’s illness was an expression of an unconscious psychic conflict that centered on questions of rebellion, autonomy, and traditional patterns of behaviors and dependence for a woman in her era. Goldstein argues that Nannette’s taking refuge in illness had to do with the historical change of the post-revolutionary era that exposed her to alternative, and more egalitarian, visions of the future. Located between traditional and modern lifestyles, Nannette literally embodied the contradictions of her historical moment. As this elegantly written book combines an erudite survey of multiple historical contexts, a micro-history of early nineteenth-century French and Savoyard medicine, gender and politics, and an imaginative conceptualization of a medical case, it should be of interest to any serious historian.

 

Michal Shapira is a Thomas Arthur Arnold Research Fellow at the Department of History, Tel Aviv University. She is a modern European historian focusing on the impact of total war and the development of expert culture in the twentieth century. She is the author of the book The War Inside: Child Psychoanalysis, Total War and the Making of the Democratic Self in Postwar Britain (Cambridge University Press, 2013).

 

2013
01/11
POSTED BY
CATEGORY
books
review
TAGS
Leave a comment

Book Review – Richard Noll, American Madness: The Rise and Fall of Dementia Praecox (Harvard 2011)

By Jesse Ballenger

As indicated by the controversies swirling around the proposed revisions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders due to be published next year, psychiatry is probably more concerned with the categorization of diseases under its purview than any other medical specialty. Yet solid knowledge of the causes and precise pathological mechanisms that might define mental illness remains more elusive than with any other sort of human affliction. In this richly detailed book, Richard Noll explores the historical predicament of psychiatry through the efforts of America’s early twentieth century psychiatric elite to integrate their field with the main currents of an emergent scientific medicine by creating a scientific classification of mental illness.

In the second half of the nineteenth century, culminating in the emergence of germ theory and the microbiological turn, medicine as a whole increasingly oriented itself around a concept of disease specificity. Disease was no longer thought of as a general process manifesting itself uniquely in each individual, but as a specific entity with distinctive signs, symptoms, cellular pathology, and a typical course and outcome. Medicine increasingly emphasized the rational investigation of biological mechanisms or physiological abnormalities in the laboratory or on the autopsy table.

By contrast, American alienism – the term used through the early twentieth century to describe the branch of medicine devoted to disorders of the mind – seemed left behind to grapple with the protean, inscrutable and seemingly intractable nature of insanity in increasingly overcrowded, understaffed and physically decaying asylums and state hospitals. Noll argues that by adopting and adapting the European concepts of dementia praecox to the American context, leading American psychiatrists transformed their field into a branch of modern medicine.

Historians of American psychiatry, pulled toward the historiographical black hole of conflicts between partisans of Freudian psychoanalysis and the bio-pharmacological turn of the past few decades, have paid far too little attention to the influence of German psychiatrist Emil Kraepelin in the first four decades of the twentieth century. Noll’s book goes a long way toward remedying that. He devotes an excellent chapter to describing how Kraepelin revolutionized psychiatry by replacing a static view of insanity as a single entity that could express itself in a number of characteristic forms in particular patients – melancholia, mania and finally terminal dementia – with the idea that mental disorders could be sorted into distinct categories based on a rigorous, quantitative study of how clinical symptoms manifested over time. This work established two main categories – manic-depressive inanity and dementia praecox – distinguished primarily on the basis of the deteriorating course and bleak prognosis of the latter. Manic depressives improved between acute episodes, and sometimes recovered completely. Patients with dementia praecox very seldom did.

Most of the remainder of the book explores how American psychiatrists like Adolph Meyer introduced and adapted Kraepelin’s methods and concepts into American psychiatry. From a series of increasingly influential positions – first as head of pathology at the Worcester Hospital in Massachusetts, then director of the New York Pathological Institute, and finally professor of psychiatry and head of the Phipps Psychiatric Clinic at Johns Hopkins, Meyer trained nearly every psychiatrist who rose to a senior administrative position in American asylums in the first half of the twentieth century.

Meyer learned Kraepelin’s methods and nosological system during a six week visit to his clinic in Heidelberg in 1896 just as the revolutionary fifth edition of Kraepelin’s textbook was published, and returned to the United States a confirmed Kraepelinian. He was enthusiastic about Kraepelin’s methods and concepts not only because they provided a scientific basis for psychiatric research, but because they provided a rationale for asylum doctors to take a more active interest in the patients who crowded their wards. Thanks to the influence of Meyer and a few other elite psychiatrists like August Hoch and E.E. Southard, dementia praecox, which did not exist in American psychiatry in 1895, became in the space of a decade the mental disorder most widely written about in American medical journals and most frequently diagnosed in American psychiatric institutions.

Although Noll’s book mostly focuses on the thought-world of elite psychiatrists, he recognizes that most American alienists practiced in a much different world in which limitations in their training, and the lack of resources and clinical demands of the institutions they worked in, made it very difficult for them to follow the psychiatric literature published in English, let alone read Kraepelin’s original work in German. Noll argues that in their hands, Kraepelin’s classification scheme became something of a diagnostic blunt instrument – with mixed results for patients. To the good, Kraepelin’s emphasis on clinical observation restored interest in patients and their symptoms, and Noll thinks it likely that some patients benefitted simply from the increased attention. Moreover, since the major categories of mental disorder were distinguished by prognosis, giving patients a diagnosis allowed alienists to say something about the future to patients and their families, and a diagnosis of manic-depressive insanity gave grounds for some hope of recovery. To the bad, Noll argues that the rising prominence of dementia praecox facilitated continued neglect. The dire prognosis of dementia praecox, which Noll estimates to have been the diagnosis for between one quarter to one half of institutionalized patients during this period, justified non-treatment or mistreatment.

Noll shows that American psychiatrists began to stretch the concept of dementia praecox almost from the moment it entered American psychiatry in 1896. In part, this reflected the relative isolation of workaday asylum alienists described above. But even elite American psychiatrists were dissatisfied with several ambiguous aspects of Kraepelin’s concept, and by 1904 Noll finds prominent neurologists and psychiatrists complaining that the term was so malleable that it could be applied to any young person with a serious mental disturbance. The imprecision with which psychiatrists used the term dementia praecox became an embarrassment to the profession when it was mocked in the sensational murder trial of Henry Kendall Thaw in 1907. As widely reported in newspapers around the world, numerous prominent alienists testified as expert witnesses for both sides in the trial and offered conflicting diagnoses, and the strange new term dementia praecox that many had used was lampooned in the closing statement of the defense attorney as “dementia Americana.”

In addition to the slipperiness of diagnosing dementia praecox, many leading psychiatrists, including Meyer, were frustrated that it implied nothing about the cause of mental illness. Kraepelin had rejected the “brain psychiatry” that developed in Germany in the 1860s and ‘70s because he thought its focus on finding the cause of mental illness in specific brain pathology was reductionist and premature. He thought that the first priority of a scientific psychiatry had to be using rigorous clinical observation to establish disease concepts that corresponded to natural disease entities. Kraepelin assumed that dementia praecox had a biological basis, probably in systemic autointoxication, but thought psychiatry should resist etiological speculation in favor of classification based on clinical observation.

Leading American psychiatrists could not easily abide such restraint. In the first two decades of the twentieth century, dozens of articles appeared in the psychiatric literature trying to establish a specific neuropathology for dementia praecox, or compiling laboratory data of various bodily functions of praecox patients to try and identify evidence of autointoxication or “endocrinopathy.”  Despite initial enthusiasm, none of these studies shed much light on the causes of madness, but Noll argues they did serve to demonstrate that psychiatry shared the sort of methods and concerns that characterized modern medicine as a whole. They also encouraged some unfortunate adventures in therapeutics. Convinced that the cause of dementia praecox was autointoxication, Bayard Taylor Holmes, a Chicago surgeon whose son was stricken with the disorder, developed a surgical treatment that involved removing part of the appendix and maintaining an open appendicostomy to allow for frequent direct irrigation of the bowel to remove the infectious material that he believed was the cause of mental derangement. Holmes’s first patient – his son – died of complications following the treatment, but he claimed modest success in the more than twenty patients he and his associates operated on. Others, most notably Henry Cotton at the Trenton State Hospital, developed similar surgical treatments that generated initial excitement, but ultimately failed to produce meaningful results. Hundreds of patients suffered the painful and often fatal consequences of the therapeutic optimism fostered by biological theories of dementia praecox.

Meanwhile, many other American psychiatrists, led by Meyer, grew scornful of narrow laboratory approaches to psychiatry and began to approach dementia praecox as a psychodynamic disorder whose origins could be found in a pre-morbid personality type marked by psychosocial introversion, disorganized habits, and maladaptive psychological reactions to the biological, social and emotional challenges of life. The search for psychogenic causes of dementia praecox led Meyer and his followers to pay increasing attention to the peculiarities of individual patients, thus moving them away from mainstream medicine’s concept of diseases as discrete entities that could be isolated from the particularities of individual patients. By the late 1920s, most psychiatrists intent on finding the psychogenic roots of insanity began to use the term schizophrenia rather than dementia praecox. Noll argues that this represents more than a simple change in nomenclature, as is often suggested, but a fundamentally different approach to psychiatry that emphasized psychological reactions as holding both the key to diagnosis and a potential means of treatment. The concept of schizophrenia proved especially attractive to more doctrinaire followers of Freudian psychoanalysis who became the dominant force in American psychiatry in the 1940s.

In an epilogue, Noll makes explicit the critique of eclecticism in American psychiatry implicit throughout the book. During the period in question, psychiatric elites like Adolf Meyer embraced ambiguity, making room under Meyer’s capacious notion of “psychobiology” for conflicting theories and practices, ranging from psychosurgery to psychoanalysis. Noll acknowledges that Meyer’s eclecticism was in part at least a “pragmatic response to clinical perplexities” that “imposed a fragile peace on rivals in the service of “the greater goal of restoring maladjusted individuals to society” (276). Though Meyer and even more the early psychoanalysts were committed to a psychogenic approach, they understood that biological research and somatic treatments were essential for the prestige of the profession.

But Noll argues that this eclecticism kept alive a tendency to emphasize the peculiar expression of disease in each individual rather than identifying the general characteristics that other branches of medicine used to demarcate specific disease entities, and ultimately marginalized laboratory research and statistical methods, and inhibited psychiatry’s integration into the increasingly powerful and prestigious modern medicine. The enforcement of doctrinaire psychoanalysis in the 1940s and ‘50s was an attempt to solve the problem by constructing a rigorous theory of psychogenic disease that could rival the explanatory and therapeutic power of biomedicine. But psychoanalysis was plagued by ambiguity and paradox and ultimately failed. From the 1960s on, progress in biomedical research into brain chemistry, psychopharmacology and genetics provided the basis for the rationalization of psychiatry that culminated in the triumphant return of Kraepelinian psychiatry as embodied in the DSM-III of 1980.

Many historians will take issue with some or all of Noll’s critique. I tend to take the clinical perplexities psychiatry has always faced more seriously than Noll, and find grounds for skepticism whenever psychiatric theories of any stripe have arrogantly asserted that the fundamental ambiguity of mental disorder has finally been vanquished by science. But the great strength of this book is that it invites intellectual engagement. Noll does not allow his own interpretive commitments to overwhelm the narrative; his representation of the world of American psychiatry during this critical period is so rich and nuanced that readers are able to develop alternative interpretations even as they consider his. In other words, it generates much more light than heat and should be widely read by historians, neuroscientists, clinicians, social scientists and educated general readers interested in understanding medicine’s efforts to come to terms with mental illness. Given the issues at play in the upcoming revision of the DSM, a work of mature, responsible historical scholarship is a timely and valuable contribution to the broad discussion we need to be having about what is at stake in psychiatric classification.

 

Jesse Ballenger is an associate professor in the Science, Technology, and Society program at Penn State University. He is the author of, among other works, Self, Senility and Alzheimer’s Disease in Modern America: A History (Johns Hopkins University Press 2006).

 

2012
08/09
POSTED BY
CATEGORY
books
review
TAGS


2 comments

Book Review – Mikkel Borch-Jacobsen and Sonu Shamdasani, The Freud Files: An Inquiry into the History of Psychoanalysis (Cambridge Univ. Press 2012)

Mikkel Borch-Jacobsen and Sonu Shamdasani, The Freud Files: An Inquiry into the History of Psychoanalysis (Cambridge Univ. Press 2012)

Mikkel Borch-Jacobsen, Making Minds and Madness: From Hysteria to Depression (Cambridge Univ. Press 2009)

 

By Simon Taylor

Beginning with the French publication of The Freudian Subject in 1982, Mikkel Borch-Jacobsen has established himself as one of this generation’s foremost historians of psychoanalysis. Strongly influenced by the intellectual atmosphere of late-1970s France – including the thought of his teachers Philippe Lacoue-Labarthe and Jean-Luc Nancy – his work is known for its dense theoretical expositions, close readings, and forensic attention to detail. It has also, from the beginning, been characterized by a relentless and penetrating critique of Freud and the psychoanalytic endeavour as a whole; as early as The Freudian Subject, Borch-Jacobsen declared that, “All this (psychoanalysis, in short) was nothing but a great egoistic dream” bolstered not only by Freud himself, but also by “the throng of parricidal listeners and readers.” (239) He has, if anything, become more strident in his criticism since then, most notably in his work on hypnosis and his deconstruction of the “first analysis,” Remembering Anna O.: A Century of Mystification. Taken together, the two works under review – The Freud Files, co-written by the equally prominent Jung scholar Sonu Shamdasani, and a collection of essays dating from 1994-2008 entitled Making Minds and Madness – constitute something approaching Borch-Jacobsen’s definitive statement on Freud and his legacy.

 

The Freud Files takes the form of a full-frontal assault on what the authors, following the example of Henri Ellenberger and Frank Sulloway, refer to as the “Freudian legend.” The legend, at least as Borch-Jacobsen and Shamdasani conceive it, consists of two separate elements: the myth of Freud’s self-analysis and what they refer to as the “immaculate conception” of psychoanalysis. Combined, these myths constitute nothing less than a complete rewriting of the historical record, a sleight of hand that subsequent generations of analysts, historians, and the public at large have been complicit in perpetrating. In tandem with the sequestering of the Sigmund Freud Archives – a cache of material protected by an extraordinary set of restrictions engineered, according to the authors, to ensure that the true record of the birth of psychoanalysis would remain off-limits to all but the faithful “guardians” (28) of Freud’s legacy and justified by the spurious demands of patient confidentiality – these myths have for many decades deliberately placed the Freudian legend beyond the scrutiny of historians. “For a discipline concerned with the past,” the authors note, “psychoanalysis is strangely allergic to its own history.” (32)

Much of The Freud Files is devoted to undermining the myths that bolster the legend. Let us take them in turn, beginning with the immaculate conception. Although virtually every aspect of Freud’s theory that we take to be distinctively psychoanalytic had been formulated by his predecessors or contemporaries – from Schopenhauer’s adumbration of repression and the sexology of Krafft-Ebing and Havelock Ellis to Hartmann’s “philosophy of the unconscious” and Breuer and Anna O.’s development of the “talking cure” – Freud and his followers first argued, and then simply affirmed again and again, that these sources had played no role in the development of psychoanalysis. Indeed, by his own account, it was not until “very late in [his] life” that Freud even read Schopenhauer and Nietzsche (106). Alfred Tauber has recently demonstrated the extent to which Freud’s professions of philosophical ignorance were a fabrication, and Borch-Jacobsen and Shamdasani are unequivocal in their assessment of Freud’s claims to “theoretical virginity”: the history that Freud so carefully constructed is nothing more than “a fable, a scientific fairytale” designed to “establish [his] autocratic political authority through affirming the absolute originality of the theory.” (106-7)

Another crucial aspect of Freud’s attempt to affirm “exclusive rights over his creation” (106) were his claims that 1) he had carried out a successful self-analysis; and 2) that this self-analysis could not – in either a technical or a moral sense – be replicated by anyone else. Freud used the first claim – the example of his self-analysis, where analysis entailed not merely observing but actively curing oneself, as Freud claimed to have done – to insist that all psychoanalysts submit to their own analysis as a prerequisite of professional development; he used the second claim to insist that such analyses could only be carried out by an external authority. As the “primal analyst,” (38) this left Freud in an incredibly powerful position, especially in the initial years of psychoanalysis: as the only authority capable of dispensing analysis, Freud established himself as the profession’s gatekeeper.

In one stroke, Freud had cemented his own position at the top of the psychoanalytic hierarchy and delegitimized the authority of his rivals. He had, furthermore, simultaneously insulated himself from any attempts at being analysed by others – which would both call into question Freud’s own omniscience and strengthen the hand of his rivals – and reserved for himself a monopoly on diagnosing the (alleged) psychopathologies of others, a power that Freud and his followers made liberal use of in their disputes with Adler, Rank, Jung, et al. It is important to understand that Borch-Jacobsen and Shamdasani’s point here is epistemological as well as institutional: “Freud’s self-analysis,” they write, “became the central pillar of psychoanalytic theory. Without it, psychoanalysis would collapse into a chaos of rival interpretations, with no means to adjudicate between them.” (52) Unsurprisingly, however, the authors conclude that what they term Freud’s “heroic self-analysis” “never took place.” (54)

It is not so much that Borch-Jacobsen and Shamdasani doubt that self-analysis is possible, as they doubt that analysis of any kind is possible. Freud’s self-analysis, like all psychoanalytic case studies, was nothing more than a “retrospective construction.” (54) Indeed, this is the most that psychoanalysis can ever hope for. As Borch-Jacobsen argues in an essayentitled “Is Psychoanalysis a Fairy-Tale?” – the answer, it may not surprise you to learn, is a resounding yes – psychoanalytic case-studies are nothing more than “historical novels or romanticized biographies” (Making Minds, 151) in the vein of Zweig or Balzac, what the novelist Paul Auster once referred to as “the anecdote as a form of knowledge.” To use the slightly clumsy neologism coined by Borch-Jacobsen and Shamdasani, these case studies represent “interprefactions,” (144-45) a reificatory process through which “Freud created facts with words.” (Making Minds, ix)

The debunking of Freud’s case-studies, beginning with his own, is the most convincing section of The Freud Files: especially impressive is the manner in which Borch-Jacobsen and Shamdasani complement their epistemological critique with a highly controlled and precise use of archival material. There are times, however, when the sheer volume of archival and primary source material threatens to overwhelm and even undermine the argument. The authors have employed what they describe as a “polyphonic” approach to quotation, which in practice entails “deliberately cho[osing] to cite excerpts in extenso, letting the historical actors speak in their own voices.” (28)

Although the logic behind this method is sound – the material, lying behind the lock and key of the Freud archives, was so difficult to access and offers such a radically different interpretation of the origins of psychoanalysis that only direct and extensive quotation can do it justice – this maximalist approach can at times lend The Freud Files the appearance of a Renaissance commonplace book. Furthermore, and contrary to the apparent expectations of the authors, many of the passages quoted do not speak for themselves. Perhaps more damagingly, the sheer volume of critical material produced to dismantle Freud’s claims has the paradoxical effect of serving to, if not necessarily justify, then certainly explicate, the defensive and revisionary strategies of Freud and his disciples: faced with overwhelming hostility (painstakingly catalogued by Borch-Jacobsen and Shamdasani) from the established medical and psychiatric authorities, Freud’s efforts to carve out a position of professional security and prestige, and his subsequent policing of those boundaries, come across as unsurprising, even understandable.

More troublingly still, the argument of The Freud Files at times resembles little more than a sustained ad hominem attack on the integrity and character of Freud and his followers. No doubt Borch-Jacobsen and Shamdasani would counter that in a discipline as intimately bound up with the personality of its founder as psychoanalysis – a body of knowledge that, after all, regards the introspective reflections of its progenitor as both foundational and paradigmatic – such a strategy is not only fair game but inescapable. The problem with this line of argument is that it presupposes that psychoanalysis is nothing more than a series of case studies and personal anecdotes. It is, however, equally plausible to argue that psychoanalysis is nothing less than the series of extraordinary metapsychological papers, bookended by “Formulations Regarding the Two Principles in Mental Functioning” and “Mourning and Melancholia,” that Freud published between, roughly, 1911-1917.

The total omission of Freud’s metapsychology is especially problematic given the severity of the authors’ conclusions: psychoanalysis, they declare, is “Nothing – or nearly nothing […]: it is a ‘machine’, a ‘whatsit’, a ‘thingumajig’ which can serve to designate anything, an empty theory in which one can cram whatever one likes.” (303) More striking still are their claims about the implications for the contemporary practice of psychoanalysis: “one could say that psychoanalysis, in a certain sense, no longer exists – or rather, never did.” (307). Borch-Jacobsen reaches similar conclusions in a number of essays contained within Making Minds, including the aforementioned “Fairy-Tale” and a piece entitled “Interprefactions: Freud’s Legendary Science” (co-written with Shamdasani) that informs much of the methodology of The Freud Files, from which we learn that “what Freud actually did […] was to form a self-confirming apparatus which could produce, suggest evidence for whatever theory one liked.” (Making Minds, 171). In “Simulating the Unconscious” Borch-Jacobsen concludes that “there is no ‘psychic reality’ to discover or to describe in the subject, only realities to produce and to negotiate with him.” (Making Minds, 136).

These are huge claims, as befits a book of the scope, ambition, and prodigious scholarship of The Freud Files. For, despite the criticisms above, the monograph and essay collection under review constitute a formidable and, for the most part, highly persuasive critique of Freud and his legacy; indeed, this review can only hint at the depth of argumentation and rich analysis contained within their pages. Nevertheless, it is hard to shake the feeling that Borch-Jacobsen’s dismantling of the psychoanalytic edifice is perhaps a little too thorough, even as its implications remain underdeveloped. Assuming that we accept the logic of his criticisms, what are we left with? What is the mind? What is mental illness beyond constructivism? Nothing? Something? There are a number of contemporary philosophers, neurologists, and psychologists who offer potential answers to these questions, but Borch-Jacobsen isn’t one of them. As an historian, perhaps he feels justified in not having to engage with such questions. Equally, however, as an historian of psychoanalysis he has, or ought to have, a vested interest in offering alternative paths for investigation. After all, if, as Borch-Jacobsen argues in the methodological essay that opens Making Minds, mental illness is nothing more than a particularly complex and fluid social construct – an open dialogue between analyst, patient, and society at large – what more is there to say on the subject? In order to answer what then becomes the truly pressing question – why does a given form or manifestation of “illness” establish itself as the predominant mode of mental expression in a particular time and place? – we must surely seek an answer beyond the confines of the history of the psyences. We must become cultural historians: that is the true implication of a history that denies the existence of the object it studies.

 

Simon Taylor is a graduate student in the Department of History at Columbia University. He specializes in modern European intellectual history, particularly the history of philosophy and the psyences. He is writing his dissertation on the medicalization of the concept of anxiety. Simon previously reviewed Alfred Tauber’s Freud, The Reluctant Philosopher for h-madness.

2012
07/30
POSTED BY
CATEGORY
books
review
Uncategorized
TAGS

2 comments

Book Review – François Dosse, Gilles Deleuze and Félix Guattari: Intersecting Lives. Trans. Deborah Glassman (Columbia University Press, 2010)

By Jon Beasley-Murray

 

Gilles Deleuze and Félix Guattari’s Anti-Oedipus surely has some of the most remarkable opening lines of any work of philosophy or cultural critique. First published in France in 1972, just a few years after the demonstrations of May 1968, its stylish bravado immediately reminds us of the attitudes struck by student agitators, and proclaims that their radical energies persist: “It is at work everywhere, functioning smoothly at times, as other times in fits and starts. It breathes, it heats, it eats. It shits and fucks. What a mistake to have ever said the id.” The original French is even more striking, playing on the fact that “id” and “it” are both “ça” (“Ça fonctionne partout . . . Quelle erreur d’avoir dit le ça.”). “It” is a machinic unconscious that is defined not by what it represents, but by what it produces: “Everywhere it is machines–real ones, not figurative ones: machines driving other machines, machines being driven by other machines, with all the necessary couplings and connections” (Anti-Oedipus 1). The question “what does it mean?” gives way to “how does it work?” As Deleuze and Guattari go on to declare in their second enquiry into “Capitalism and Schizophrenia,” A Thousand Plateaus: “We will never ask what a book means, as signified or signifier: we will not look for anything to understand in it. We will ask what it functions with, in connection with what other things it does or does not transmit intensities, in which other multiplicities its own are inserted and metamorphosed” (A Thousand Plateaus 4). They therefore refuse any attempt to derive meaning from biography, to reduce the work to its author(s). Indeed, they disclaim authorship as anything but a matter of arbitrary convenience and custom: “Why have we kept our own names? Out of habit, purely out of habit. To make ourselves unrecognizable in turn. [. . .] We are no longer ourselves. Each will know his own. We have been aided, inspired, multiplied” (A Thousand Plateaus 3-4).

Deleuze and Guattari’s skepticism about interpretation and authorship does not, however, mean that any attempt to write their biography is doomed. In the first place, there is no reason why a biographer should accept his or her subjects’ own strictures. There is no need for a Life of Marx to be Marxist, for instance. Otherwise, all biographies would be hagiographies, explications written solely by disciples and camp-followers. They would be third-party autobiographies, attempts to outline a subject’s own ideal self-understanding without taking the distance necessary for critique or contextualization. And surely Deleuze and Guattari’s denial of meaning or authorial presence should put any analyst on the alert: what are they trying to hide? Indeed ultimately Dosse, rather conventionally, concludes that their work is best explained “as a displaced effect of the shattering consequences of the values and triumph of Nazism” (520). It is shaped by the fact that each just missed World War II and experienced its trauma only “tangentially and after the fact” (Deleuze’s older brother joined the Resistance and was caught and killed en route to a Concentration Camp), but that both men found compensation in May ’68, in which they “participated fully.” “Particularly sensitive to the issues of their period,” Dosse claims, “they immediately understood that these events were creating a rupture and starting something new” (521). But precisely the bathos of this conclusion makes us wish for a rather more radical approach to biography. For even if one were to accept fully their arguments against biographical interpretation, one could still quite easily imagine a Deleuzoguattarian account of the machinic processes, the connections and multiplicities and intensities, that the proper names merely cloak. If “Deleuze and Guattari” is better seen as an assemblage or “arrangement” rather than simply the conjunction of two individuals, the makings of that arrangement–both its constituent elements and its product–can still be mapped and followed, albeit schizoanalytically rather than psychoanalytically. These two profoundly different men–Deleuze the stay-at-home philosopher, Guattari the ever-restless activist with a writer’s block–entered into a dance of mutual seduction and becoming not unlike that traced by orchid and wasp in their own analysis. Guattari unsettled Deleuze, firing him up and reframing his philosophy in newly political terms; and Deleuze made Guattari sit down at his desk every morning, and then “mail his daily draft” (7). Yet for all the intensity of their relationship, over almost three decades, they never stopped using the formal vous with each other.

One might even imagine a hybrid approach to the joint biography of Deleuze and Guattari, which would examine the eminently bourgeois origins of these two would-be firebrands–Deleuze’s father was an engineer whose politics were decidedly right-wing, even anti-Semitic; Guattari’s ran a factory and “became the director of a fairly prosperous business”–and show how they tried to escape, to make themselves “unrecognizable,” along what they would come to call a “line of flight,” but with sometimes uncertain success. For instance, for all his denunciation of familialism and denigration of family ties, Guattari was very close to his mother and devastated by her death in 1969, repeating over and over “I am an orphan” (70). And perhaps the most enigmatic of Deleuze’s gestures was his last, as he killed himself by leaping from his Paris apartment window: “suicide was so incongruent with Deleuze’s embodiment of a vital force and his philosophy of life that certain of his friends tried to see it as a send off, an ultimate final act” (498). But why in any case should we demand consistency of philosophers or writers? Is that not just another example of the reductionism that mars too many biographies? Or to put it in more Deleuzoguattarian terms, of course Deleuze and Guattari’s own lines of flight could become sites of reterritorialization or (as they put it in A Thousand Plateaus) could “sometimes end in chaos, the void and destruction, and sometimes lock us back into the strata, which become more rigid still, losing their degrees of diversity, differentiation, and mobility” (554). Dosse describes Guattari’s “nearly catatonic state” (427) during the depression that overcame him in his final years, as he sat “with a pillow pressed to his stomach as if to protect himself from the outside world, watching television programs for days on end” (425). He suggests that this decline owed in part to “many psychological frailties that had never been sufficiently addressed” (423) and refers us somewhat obliquely to Guattari’s early years, to childhood trauma, not least the “brutal encounter with death” when at nine years old young Félix witnessed his grandfather’s demise (24). (Though perhaps the truly traumatic aspect of this scene came when his grandmother “cut the ends of [the grandfather’s] ears to try to get his heart beating” and then “put a newspaper over her husband’s head to keep the flies off him” [24].)

The problem with Dosse’s book is that far too often it feels as though there is simply no particular strategy at work. It opens with a somewhat stunted attempt at conventional biography, which breaks off almost as soon as each of its subjects leaves home, after which we hear very little of parents or brothers, wives or children. Indeed, it is something of a shock when these familial figures re-appear around the deathbed or at the funeral. Guattari’s elder brother, for instance, is pictured “surprised and disturbed by the enumeration of [Félix’s] various feminine conquests in front of his brother’s tomb” (494), but we might be equally surprised to be reminded that Guattari had a brother at all. And yet the book features a couple of intriguing photographs of the Guattari clan–one showing the three brothers with their trousers rolled up as though coming from the beach, yet two are dressed in jackets and one even wears a tie plus a neatly folded handkerchief in his top pocket. But nothing is said of this. Likewise, there are a couple of truly extraordinary images of Deleuze with his brother, Georges: one in which they are both in some kind of costume, Gilles a toddler with a top hat and polka dot jacket; and the other in which they are wearing tennis gear, Gilles turning his head towards his sibling. In both instances, the older brother lays his hand, gently and protectively, on the younger boy’s shoulder. But having briefly noted the significance of Georges’s wartime death, Dosse never returns to the subject.

More consistently, the book tends towards offering a portrait of an intellectual milieu, not unlike Elisabeth Roudinesco’s magnificent collective biography of French psychoanalysis, Jacques Lacan and Co. In that Deleuze and Guattari came into contact with just about every major figure of post-war French philosophy and psychiatry, as well as many other major cultural and intellectual figures–Deleuze was a high-school friend of the novelist Michel Tournier and Guattari collaborated with playwrights, painters, and film directors–we are often confronted with long lists of names, some more familiar to Anglo-American readers than others. The “intersecting lives” outlined here belong also to Jean Hyppolite, Louis Althusser, Jean Oury, R. D. Laing, Michel Foucault, Toni Negri, Jean-François Lyotard, Alain Badiou, Eric Alliez, and on and on. Yet Dosse remains too focused on his two principal actors to make this successful as an institutional biography. The secondary characters only have the spotlight so long as they interact in some way with Deleuze and Guattari, and what happens when they are on their own is ultimately of as little interest as Rosencrantz and Guildenstern’s adventures are to Shakespeare’s Hamlet. As a result, for instance, we get here a strangely partial view of Badiou, who features only as a putative rival to Deleuze at Vincennes, leading Maoist hit-squads to interrupt his colleague’s seminars, and later (allegedly) traducing his work in Deleuze: The Clamor of Being. Meanwhile, key absences make this very incomplete as a history of post-war philosophy after structuralism. Most notably, perhaps, of Jacques Derrida there is barely a trace.

Dosse observes that multiplicity, connection, and heterogeneity are basic features of both Deleuze and Guattari’s worldview and their literary and philosophical style. Their work is astonishingly eclectic and wide-ranging, touching on Anthropology, History, Politics, Biology, Geology, Mathematics, and so on. It may be in homage to this proliferation that Dosse, too, amasses information from his exhaustive research, wide reading, and many interviews of everyone from Deleuze’s wife Fanny or Guattari’s son Bruno to students, friends, collaborators, and critics. But overwhelmingly the logic structuring this concatenation of material is less the “creative stammering” of “and . . . and . . . and“ that Dosse quotes from Deleuze in his book’s penultimate paragraph (523), and more the banal contiguity of “also” that suggests proximity without any real relation. “Also” is Gosse’s conjunction of choice, appearing every other page or so. To take one series almost at random: “Deleuze and Foucault also admitted” (316); “What was also playing out” (317); “and also strongly influenced” (318); “Foucault also drew on Stoic arguments” (319); “they were also very different” (320); “narratives that were also manuals” (321); and so on and so forth. Or frequently there are simply no conjunctions at all. Non sequitur piles up on non sequitur. Chronology is abandoned; to take but one example, the chapter entitled “The Year of Combat: 1977” in fact takes us in one page from 1997 to 1970 to 1995 to “the 1970s” to “the late 1980s” (367). The overall effect is often extremely bitty and disconnected. Quotations (a sentence or more long) are rarely introduced or contextualized, and it is only by recourse to the endnotes that a reader has any idea who is saying what when. This may perhaps sound suitably Deleuzoguattarian in its erasure of individuality or its bricolage of elements from diverse sources, but in practice it sacrifices any sense of texture, any feeling of differentiation or difference as information and opinion simply agglomerate, one damn thing after another. Accounts of texts by either Deleuze and Guattari or both are built up by collecting piecemeal other people’s précis or other people’s evaluations. The effect is often confusing and rarely illuminating: this is seldom a biography from which you feel you have gleaned a better understanding of Deleuze and Guattari’s work than you would by simply reading it yourself.

All of which prompts the question as to the purpose of this biography. If the life does not illuminate the work, and if the life is of no particular intrinsic interest itself (as is especially the case of Deleuze, who seems mostly to have read, written, and taught, and to have occasionally tagged along to events with his buddy Guattari), then why bother? Dosse suggests that one of his aims is to underline Guattari’s contribution to the collaboration, but a slim article rather than a bloated book could have achieved the same end. Especially compared to the brio and bravado of Deleuze and Guattari’s own work, which gets to the point so quickly and so memorably (“What a mistake to have ever said the id. Everywhere it is machines . . .”), it is a shame that their biography proceeds with so little drive or desire.

 

Works cited

 

Deleuze, Gilles, and Félix Guattari. Anti-Oedipus: Capitalism and Schizophrenia. Trans. Robert Hurley, Mark Seem, and Helen Lane. London: Athlone, 1984.

—–. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Brian Massumi. London: Athlone, 1988.

 

Jon Beasley-Murray teaches at the University of British Columbia, where he is an Assosciate Professor in Hispanic Studies, specializing in Latin American studies and in social and political theory. He is the author of Post-Hegemony (University of Minnesota Press 2011).

2012
07/25
POSTED BY
CATEGORY
books
review
Leave a comment

Book Review – Junko Kitanaka, Depression in Japan: Psychiatric Cures for a Society in Distress (Princeton 2011)

By Clark Lawlor

Junko Kitanaka’s book richly deserves the superlatives that reviews other than this one will be sending in its direction. A fruitful combination of medical history, ethnography and sociology, Kitanaka guides us with an expert knowledge and lucid style through the complexities of Japanese depression as it is now and as it was in the past. Thus it stands to be of interest both to historians of medicine who work in early modern periods and those who are concerned with the present and how psychiatry moves forward in our own time. Kitanaka has had plenty of experience with Western psychiatry from her time in North America, and provides something of a comparative study (although this is by no means the stated aim of the book) of the way Japanese and Western cultures of psychiatry have converged and diverged. The book is never less than fascinating and should be read by any historian of psychiatry, or indeed anyone interested in the history of depression.

The book is divided into three main parts: depression in history (an excellent short history with cross-cultural applications), in clinical practice, and in society. The first part deals with the progress of depression from ‘the premodern language of depression’, ‘the expansion of psychiatry into everyday life’, the debate in the early twentieth century about neurasthenia as a disorder of overwork or defective (‘weak’) personality, and finally to the point at which ‘the current medicalization of depression’ has not necessarily resulted in the same potentially reductive biochemical emphasis so prevalent in the West, particularly the United States (67). Instead, Japanese psychiatrists have annexed the idea of depression as a disease of the whole person, a ‘Typus Melancholicus’, who is prone to depression because he (we will return to gender later) is too hard-working and has over-internalized the Japanese ethic of productivity and corporate loyalty. Depression thus becomes a disease of fatigue, but to be treated in pharmaceutical manner rather than via the social structures that determine this discourse of work.

The second part examines how depression has been dealt with at the coal face of clinical practice, for psychiatrists as well as patients. It is a great strength of this book that it combines history with ethnography, so that this part is ‘based on two years of ethnographic fieldwork I conducted at three psychiatric institutions (a university hospital, a private mental hospital, and a small clinic specializing in psychosomatic medicine)’ (85). A working knowledge of real-world interactions between patients and their psychiatrists gives the book a practical and authentic insight. The first chapter in this section demonstrates how psychotherapy for depression has been a ‘taboo’ treatment for Japanese patients, and how psychiatrists have actively avoided wandering into the realm of the patient’s subjectivity and possibilities for self-analysis and reflexivity. Rather, they have concentrated on providing biological and social explanations for depression, partly motivated by a fear of ‘colonizing’ the patient and – to mix the metaphor-  unleashing psychological forces that the ‘lid’ of biomedical explanations had kept under control (104).  The next chapter deals with the limits of this method, and in particular the case of suicide, which is usually regarded in Japan as an act of free well and a ‘moral act’. The explanations provided by Japanese psychiatrists conflict with this self-determinism as they strip away that very aspect of suicide that seems most to figure individual agency. These tensions are apparent when patients are not persuaded by the psychiatric discourse of passive determination by outside forces, whether social or physical.

The final chapter in this section challenges the Western conception of depression as a ‘female malady’ (although of course this is only a particular representation of gendered depression as recent work on both depression and hysteria has demonstrated) and shows Japanese depression to be regarded as a disease of both sexes, but with the twist that representations of male depression are structured by a public discourse of depression ‘that highlights their sense of fatigue and overwork as well as the injustice of economic and social systems’ (86). Female depression often resists the ‘paternalistic’ relationship with the psychiatrist (are they all men?) that smooths the male road to recovery because women ‘rarely seem to link their suffering to the recognized structural causes of depression’.  The way women manifest their resistance to the encouraged dependency on the psychiatrist is to switch the particular practitioner until they find the ‘right’ one. This is a situation that is starting to change, argues Kitanaka, as the gender politics of Japanese society shifts, and as the neoliberal imperative of modern Japan stimulates the individual to take control of her or his destiny rather than ceding power to the psychiatrist.

The last part of the book (III) moves beyond the asylum and into the wider social realm, where psychiatry is employed as a means of representing and critiquing the ills of that realm. The first chapter uses Rabinow’s concept of ‘bio-sociality’ –in which a patient can empower him or herself via medical label or diagnosis, despite a lack of power in the social sphere – to analyse the status of overwork suicide and depression in Japan. Kitanaka shows that psychiatrists ‘have become engaged in a social movement against overwork that has brought doctors, lawyers, and depressed workers and their families together’ (153). The fact that workers have managed to win legal battles that argue for overwork depression and suicide brings psychiatric discourse firmly into the public realm, but with this transition comes a series of conflicts that need to be negotiated. If a willing worker commits suicide from overwork, where does that leave the traditional Japanese work ethic? Similarly, within medical discourse itself, what do doctors do when they intrude into the moral rather than scientific arguments about the causes of depression in Japanese workers?

The following chapter (10) examines the way in which medicalization over the course of a decade has had effects in law and policy, public debates about antidepressants, and industrial management. This again uses fieldwork conducted in 2008/9, and is the better for it. Medicalization, it transpires, has not been straightforward, and has involved the medical community in the demand from government and industry to find a scientific way of managing depressed workers. Different groups (medics, lawyers, managers) have different perspectives on the nature of depression and the depressed person, including their susceptibility to work stress, and stress’s connection to depression. Finding the best way of dealing with work-related depression is a political hot potato, not merely a medical issue.

Kitanaka concludes the book by connecting the local issues of Japanese medicalization with global politics. The result chimes with the Western emphasis on drugs:  ‘Despite the seemingly redemptive role it has played in Japan, however, psychiatry continues to be characterized by a dual structure: while providing a socializing language that has helped popularize depression, psychiatry retains its biological principles at the core of its practice. Without fundamentally altering the way it operates-or generating a new theoretical and clinical framework to address the social nature of people’s “depression”-psychiatry has relegated the depressed to the pharmaceutical management 0f everyday distress’ (193). This ‘aggressive pharmaceuticalization’ promoted by Japanese psychiatry ditches the psychological and social aspects of depression, at least in terms of treatment. Needless to say, this focus on the biological is not generally a positive outcome for the suffering patient. The future of Japanese depression goes in some ways in tandem with Western depression: both cultures need to move beyond the crudely pharmaceutical and to address the social and psychological structures that (albeit differentially) affect both types of (late?) industrial societies.

This review hardly does justice to the depth of scholarship (both historical and ethnographic) and complex yet lucid arguments that constitute Kitanaka’s brilliant  book. This is the first place one should look to gain an understanding of Japanese depression, contemporary and historical, and, what is at least as rewarding, should be taken as a model of what cultural and ethnographic research can achieve when conducted at this level of excellence.

Clark Lawlor teaches at the University of Northumbria, UK. He is the author of several works, including most recently, From Melancholia to Prozac: A History of Depression (Oxford 2012).

2012
06/01
POSTED BY
CATEGORY
books
review
TAGS

2 comments

If you need translation use

http://translate.google.com

 Subscribe in a reader

To contact us

hpsychiatry [at] gmail.com
wordpress visitors
Site Meter
%d bloggers like this: