Syllabus: Reaume, “Mad People’s History”

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

Geoffrey Reaume is Associate Professor in the Critical Disability Studies graduate program at York University, Toronto, where he has taught since 2004. He has written two books: Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940 (Oxford University Press Canada, 2000; re-issued, University of Toronto Press, 2009, 2010); and Lyndhurst: Canada’s First Rehabilitation Centre for People with Spinal Cord Injuries, 1945-1998 (Montreal & Kingston: McGill-Queen’s University Press, 2007). Reaume is a co-founder of the Psychiatric Survivor Archives, Toronto (founded 2001), has given over 80 history tours of the patient built nineteenth century Toronto Asylum boundary walls at the Centre for Addiction and Mental Health based on research from “Remembrance of Patients Past” and introduced and has taught Mad People’s History at all three universities in Toronto.

The purpose of Mad People’s history is to understand the history of madness from the perspectives of people who have lived this past. Its purpose is also to engage this history with students who have or are currently experiencing madness, either themselves or in relation to relatives and friends. In particular the course is intended to provide an alternative to the medical model perspectives which have dominated the history of psychiatry. The use of the term “Mad People” in the title is intended to ensure it is about the people without whom this history would not exist. It is also intended to ensure that the course is not considered medical model in approach, though people with medical model perspectives are included along with the entire range of perspectives from anti-psychiatry to pro-psychiatry and views that are in between these perspectives.

Generally, the course provides a historical perspective that is highly critical of the medical model for its dominance in modern psychiatry and instead seeks to include broader perspectives that are inclusive of perspectives that interpret madness from wider social influences, such as the impact of poverty, gender, class, race, disability and sexual orientation. The course also seeks to include perspectives that are not only about “famous” mad people but include more sources from people who are less well known so that it is not a “great mad people’s” history course, but rather one which is more broadly representative of the vast majority of unknown mad people. Methodological issues about not being able to access the perspectives of the poorest mad people, who left no writings given their lack of resources and absence of educational opportunities in so many cases, are also discussed to appreciate the limits in understanding this past. The silences in Mad People’s History are thus as important to understand as what we discuss in this course. Finally, connections between past and present are stressed throughout the course to provide context for current developments while appreciating the contributions and experiences of mad people throughout the ages.

An article about this course is available in the journal Radical History Review, 94 (2006): 170-182.

Advertisements for Psychotropic Drugs in East Germany

"Papachin – for old age vertigo"

Going through some old boxes of notes, I came across the following:  a number of East German advertisements for stimulants, sleeping pills, and anti-anxiety medications.  The ads are all from the psychiatric journal Psychiatrie, Neurologie und medizinische Psychologie.  Unfortunately, I did not keep notes on the exact dates of the ads, but a few, at least, appear to be from around 1963.

For those interested, Director Volker Hess, Viola Balz, and Ulrike Klöppel at the Institute for History of Medicine in Berlin are presently conducting research on a project examining the manufacture, distribution and uses of psychotropic drugs in East Germany –“Psychochemicals Crossing the Wall: Die Einführung der Psychopharmaka in der DDR, 1952-1989.”

"Medication for sleeping and getting back to sleep – Dormutil"

"Fast acting – deep and peaceful sleep – waking without depression: Dormutil"

An ad for the stimulant "Aponeuron," comparing its effectiveness to caffeine

"Neuroton – for treatment of anxiety, tension, depressions"

– Eghigian

Syllabus: Kushner, “Mental Health and Public Health” and “Madness, the Brain, and Culture in Interdisciplinary Perspective”

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

Howard I. Kushner is the Nat C. Robertson Distinguished Professor of Science & Society at Emory University where he holds a joint appointment as Professor in the Department of Behavioral Sciences and Health Education in Rollins School of Public Health and in the Graduate Institute of Liberal Arts in the College of Arts and Sciences. Kushner, a historian of medicine, is author of four books, including American Suicide: A Psychocultural Exploration (1991) and A Cursing Brain? The Histories of Tourette Syndrome (1999) and numerous articles on medical and psychiatric history in journals including Lancet, the Bulletin of the History of Medicine, Perspectives in Biology & Medicine, Journal of the History of Medicine, Journal of Pediatric Infectious Disease, and Pediatric Cardiology.  He is co-editor of a special issue of BioSocieties, 5 (March 2010) entitled “Drugs, addiction and society.”  He is currently working on a book-length study of the history of laterality and mental disorders.

Kushner’s course, “Madness, the Brain, and Culture in Interdisciplinary Perspective,” is an interdisciplinary exploration of mental disorders in psychological, neurobiological, historical and cultural perspective. Conditions examined include autism, hysteria, schizophrenia, depression, bi-polar disorders, post traumatic stress disorder, multiple personality disorder, eating disorders, attention deficit, and Tourette syndrome.  The reading and discussions consider the impact of racism, class, and gender on the construction of, explanations for, and interventions developed to treat mental illnesses. All these syndromes will also be viewed in the context of an increasing public health concern with mental health and mental illness.  Attention is paid to the putative neurobiological and psychiatric mechanisms associated with these disorders.

Syllabus: Vijselaar, “History of Psychiatry: The Asylum, Inside Out”

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

Joost Vijselaar is senior researcher at the Trimbos Institute (The Netherlands Institute for Mental health and Addiction) and professor in the history of psychiatry at Utrecht University, as such he is a member of the Descartes Centre in Utrecht. He has published extensively on the history of Dutch psychiatry, among others a number of books on the history of individual psychiatric hospitals (for example on the famous asylum Meerenberg in Bloemendaal). Alongside he studied the reception of animal magnetism in the Netherlands in a comparative perspective, resulting in the book ‘The magnetic soul’: De magnetische geest. Het dierlijk magnetisme 1770-1830 (2001). He was involved in the creation of the national museum for psychiatry ‘Het Dolhuys’ (‘The Madhouse’) in Haarlem 2005. Recently he completed historical-sociological research on patient records from the first half of the twentieth century, published as Het gesticht, enkele reis of retour (or: ‘The asylum, single fare or return’). Currently he is working on a biography of the Dutch reformer of psychiatry J.L.C. Schroeder van der Kolk (1797-1862). The main focus of his research these days is on the use of electricity in explanation and therapy of mental illness and nervous disease from the eighteenth century onwards.

Bachelor research seminar – The Asylum, Inside Out. Department of History and Art History, Utrecht University

This course is an intensive research seminar, part of an obligatory program during the third and last year of the bachelor study in the Department of History. It comprises an introduction to the theme (in this case the history of the Dutch asylum), the analysis of both primary and secondary sources, independent research by the students themselves on a subject of their own choice, and the writing of a final essay (30 pages A4, spaced 1,5). The essay is regarded as the bachelors thesis. As many students do not have first-hand experience in analyzing primary sources and are not acquainted with archives, I emphasize the importance of reading and interpreting primary source material, requiring students to analyze such sources in class within the context of the secondary literature. As part of the course I ask students to prepare a research proposal more or less according to the regulations of the National Organisation of Scientific Research. An important aim of the seminar, therefore, is the training of historical skills.

As to the history of psychiatry, I use Roy Porter’s Madness, a brief history as a general introduction, complemented by the book of Ido Weijers and Ruud Abma (both of Utrecht University) Met gezag en deskundigheid (a history of the profession of psychiatry in the Netherlands) as the overview of the Dutch history. Articles and book chapters pertaining to specific subjects are used as supplementary literature. The program covers the coming into existence of the asylum during the late 18th and early 19th centuries, the development of the therapeutic regime, the organization and the disciplines of psychiatry up to the 1950s, and both the antipsychiatric movement and the process of deinstitutionalization, focusing on the question (particularly relevant to the Netherlands) of whether the asylum is disappearing. As stated above, students read and analyze primary texts such as articles, chapters of main textbooks, annual reports, ego documents, and architectural descriptions.

Subjects that students in the past have dealt with in their research were, among others: the architectural history of a city asylum; occupational therapy during the interwar years; the character of the Dutch central Jewish asylum; orthodox protestants and psychoanalysis; military psychiatry in the Dutch East Indies; the influence of military psychiatry on antipsychiatry; lobotomy in the Netherlands; the psychoanalysis of psychosis at the University of Leyden around 1930; the therapy of anorexia nervosa, etc.

This year I will organize a similar research seminar on the history of psychiatry and electricity from the 18th century to the present.

Syllabus: Crozier, “The History of Psychiatry”

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

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

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

New issue of Culture, Medicine and Psychiatry

A new issue of  Culture Medicine and Psychiatry has been released. Included are two articles related to recent psychiatric history in Israel and Malaysia. You will also find a Case Study questioning the exportation of the US recovery-oriented mental health system to the rest of the world. Titles, authors and abstracts are listed below.

From Posttrauma Intervention to Immunization of the Social Body: Pragmatics and Politics of a Resilience Program in Israel’s Periphery by Keren Friedman-Peleg and Yehuda C. Goodman

This article traces a critical change in the professional therapy of posttraumatic stress disorder (PTSD): from treatment of a disorder borne by individuals to treatment of an anticipated disorder to be prevented by fortifying the entire population. A community resilience program in the city of Sderot in southern Israel, which has been subjected to Qassam rockets by its Palestinian neighbors across the border, serves as our case study. Drawing on an ethnographic study of this new therapeutic program, we analyze how the social body that the professionals attempt to immunize against trauma was treated. In particular, we follow the various practices used to expand the clinical. We found that the population was split into several groups on a continuum between the clinical and the preclinical, each receiving different treatment. Moreover, the social body managed according to this new form of PTSD was articulated through ethnic and geopolitical power relations between professionals from the country’s center and professionals from its periphery, and between the professionals and the city’s residents. Finally, we discuss how this Israeli case compares with other national sites of the growing globalization of PTSD, like Bali, Haiti and Ethiopia, which anthropologists have been exploring in recent years.

Malaysian Moslem Mothers’ Experience of Depression and Service Use by  Nor Ba’yah Abdul Kadir and Antonia Bifulco

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia. 

Cultural Case Study: Culture, Stress and Recovery from Schizophrenia: Lessons from the Field for Global Mental Health by Neely Laurenzo Myers

This cultural case study investigates one U.S. psychosocial rehabilitation organization’s (Horizons) attempt to implement the recovery philosophy of the U.S. Recovery Movement and offers lessons from this local attempt that may inform global mental health care reform. Horizons’ “recovery-oriented” initiatives unwittingly mobilized stressful North American discourses of valued citizenship. At times, efforts to “empower” people diagnosed with schizophrenia to become esteemed self-made citizens generated more stressful sociocultural conditions for people whose daily lives were typically remarkably stressful. A recovery-oriented mental health system must account for people diagnosed with schizophrenia’s sensitivity to stress and offer consumers contextually relevant coping mechanisms. Any attempt to export U.S. mental health care practices to the rest of the world must acknowledge that (1) sociocultural conditions affect schizophrenia outcomes; (2) schizophrenia outcomes are already better in the developing world than in the United States; and (3) much of what leads to “better” outcomes in the developing world may rely on the availability of locally relevant techniques to address stress.

Click here for more information.

New Yorker Magazine: A Case of Psychopathy in New Zealand

Colin Bouwer

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

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

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