“Quantified Selfers”: The Future of Psychological Enhancement?

Financial Times this month featured an article entitled “Invasion of the Body Hackers” by April Dembosky.  The piece examines the first-ever Quantified Self Conference and the community of users and designers interested in what is referred to as “self-tracking systems.”  Dembosky describes this new trend in engineering and design this way:

The concept of self-tracking dates back centuries. Modern body hackers are fond of referencing Benjamin Franklin, who kept a list of 13 virtues and put a check mark next to each when he violated it. The accumulated data motivated him to refine his moral compass. Then there were scientists who tested treatments or vaccines for yellow fever, typhoid and Aids on themselves. Today’s medical innovators have made incredible advancements in devices such as pacemakers that send continuous heart data to a doctor’s computer, or implantable insulin pumps for diabetics that automatically read glucose levels and inject insulin without any human effort.

Today in Silicon Valley, the engineers who have developed devices for tracking their own habits are modifying them into consumer-friendly versions and preparing to launch them on a largely unsuspecting public. Though most people would cringe at the idea of getting a mineral read-out every time they visit the loo, entrepreneurs and venture capitalists see a huge market for consumer-focused health and wellness tools, using the $10.5bn self-help market and $61bn weight loss market as indicators of demand. Self-quantifiers who work at large technology companies such as Intel, Microsoft and Philips are drawing their bosses’ attention to the commercial opportunities. Public health advocates and healthcare executives are starting to imagine the potential the data could hold for disease management and personalised drug development.

Hugh Freeman, 1930-2011

HUGH FREEMAN, 1930-2011

Obituaries have just been published of the psychiatrist and historian, Hugh Freeman, who died on the 4th May at the age of 81.

Freeman will probably be best known to list members as one of the founders of the journal, History of Psychiatry and the editor of a number of essay collections on the history of psychiatry in Britain.  These include the two volume, 150 Years of British Psychiatry (London: Gaskell/Athlone, 1991 and 1996) edited with German Berrios;  A Century of Psychiatry, (London: Mosby-Wolfe, 1999),  and Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century (Amsterdam: Amsterdam University Press, 2005) edited with Marijke Gijswijt-Hofstra, Harry Oosterhuis and Joost Vijselaar.

After retiring as consultant psychiatrist to Salford Health Authority, Freeman was engaged in large scale history of psychiatric policy in post war Britain under the supervision of John Pickstone.  Parts of this work have been published including:

‘Mental Health: Policy and Practice in the NHS’, Journal of Mental Health 7.3 (1998): 225-39.

‘Mental Health Services in an English County Borough before 1974’, Medical History 28 (1984): 111-28.

The Times obituary was published on the 16 June but is only available to subscribers.  The Guardian obituary is open access here.

Dr Rhodri Hayward

School of History

Queen Mary, University of London

LONDON E1 4NS

r.hayward@qmul.ac.uk

http://www.qmul.ac.uk/emotions

New article in the NYRB: “The Illusions of Psychiatry”

one flee

The New York Review of Books contains an article by Marcia Angell dealing with psychiatry and its history. The piece, in which the author critically discusses the DSM, the pharmaceutical industry and other such topics, begins thus:

In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it. Here I discuss the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—often referred to as the bible of psychiatry, and now heading for its fifth edition—and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider’s view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry.

The entire article can be accessed at here.

For Angell’s first article entitled “The Epidemic of Mental Illness” (dated 23 June 2011), see the following link.

New Issue – Histoire@Politique

A new issue of Histoire@Politique is out and is dedicated to the expertise of biopolitics. It includes an article by Jean-Christophe Coffin dedicated to the French psychiatrist Louis Le Guillant. The abstract reads:

Le travail s’appuie sur les propos du psychiatre français Louis Le Guillant qui, dans les années 1960, s’est interrogé sur les manières d’enquêter sur la jeunesse. Ses travaux amorcent une réflexion sur les pratiques cliniques et la construction du regard psy sur l’adolescence et c’est à ce titre que nous les avons mobilisées pour analyser leur pertinence par rapport au travail d’expertise de la jeunesse mené à notre époque contemporaine. La présence accrue du psychiatre de l’enfant et de l’adolescent au sein de notre société est un fait majeur et qui distingue les deux époques. Cependant, et en dépit d’autres transformations, l’article suggère que bien des difficultés identifiées ainsi que des critiques formulées par Le Guillant demeurent encore pertinentes pour comprendre le travail de l’expert. À bien des égard, le dispositif contemporain de construction du savoir sur la jeunesse emprunte à un système de représentations qui n’est pas totalement modifié par rapport à des années plus anciennes.

Book Review – Babette Quinkert, Philipp Rauh, Ulrike Winkler (eds.), Krieg und Psychiatrie, 1914-1950. (Beiträge zur Geschichte des Nationalsozialismus, Vol. 26, Göttingen: Wallstein 2010)

By Stephanie Neuner

Interest in the subject „War and Psychiatry“ amongst historians today encompasses a field of study broader than merely an analysis of the development of military psychiatry. Accordingly, this collection focuses on the multilayered interactions between psychiatric science, warfare and politics before, during and after the Second World War. It focuses on the concrete practice of military psychiatry and underscores the radicalization and the ethical paradigm shift in psychiatry during the Second World War in Germany. At the same time, it examines the common social discourses and overarching ideas that served the purpose of processing the individual and collective psychological effects of the war.  It becomes especially clear through international comparison that psychiatric science serves as an important authority that lends structure and order to a military as well as a civilian society.

It is the methodological goal of the authors, by accessing recently discovered sources such as medical records, to shed light upon the treatment of people with psychological (also war related) disorders by looking „from below“, namely from the patient‘s perspective. Certainly an examination of these sources gives a more intimate portrayal of the daily treatment regime; however, the prevailing source material consists of recordings of medical assessments and medical histories from the „doctors‘ perspective“ (M. Foucault) and not from the experiences of the patients. Nevertheless, it is the insight gained through the examination of the day-to-day psychiatric practice that makes the volume so interesting and readable. It is a testimony to the authors‘ merit that through intensive research into the psychiatric practice during and after the war that such an exemplary portrayal has been achieved and new research findings have been presented.

Beginning with the problematic heritage of the First World War, Jason Crouthamel offers interesting snapshots of the struggle of shell-shocked veterans to receive not only their war pensions but also recognition for their war service after 1933.  He offers evidence that veterans sympathetic to National Socialist ideals were more likely to be awarded health and retirement benefits after 1933, but only for those who had sustained somatic war injuries or veterans who sustained psychological damage due to the societal upheaval caused by the Revolution of 1918.  Certainly, the conflict over recognizing the legitimacy of psychological war wounds escalated during the National Socialist regime; and of course, this can be interpreted as a conflict between different ways of remembering the war that fluctuated between hero worship on one side and an admonition of the power of destruction on the other. Nevertheless, one may want to add, that the fate of the war neurotics was largely determined by National Socialist bureaucracy when casting judgment upon an individual’s ability to work and so-called „Erbgesundheit“ (hereditary health). Accounting for the strictly organized system of retirement benefits in cases of psychologically disabled people after 1934 one must ask the question: how much room was left for negotiating retirement benefits?

Philip Rauh follows the fate of shell-shocked soldiers who were hospitalized or institutionalized during National Socialism and killed through „Euthanasia“ or so-called „T4 Actions“. Contrary to the policy that veterans should be „spared“ from being dispatched in the end, wartime service was not a guarantee against finally being condemned to death. The same selection criteria applied to veterans, namely: ability to work, discipline and clinical prognosis. Much later in the book, we find the thematically well linked article by Sascha Topp about euthanasia of children and the author‘s detailed descriptions of the case of a four-year-old girl, and especially the role her parents played in the dispute surrounding her killing.

The „Annihilation of Unworthy Lives“ within Germany was also continued in the occupied territories during the course of the war. Gerrit Hohendorf and Ulrike Winckler exemplify this with the psychiatric ward in Mogilew, Belorussia. In 1941/1942 all the patients were killed with the cooperation of the Army and the SS. The annihilation of the inmates in Mogilew followed the same scheme by which patients in other clinics and handicapped institutions were eliminated. First, patients were malnourished, then those unable to work were killed, and finally, all others remaining were annihilated. The liquidation of the patients followed primarily utilitarian motives, above all, in order to secure supplies for the army.

This is followed by Henning Tümmers’ exploration of the military psychiatric discourse and practice in Germany after 1939. Central to the understanding of the political and scientific approach to psychological disorders like shell-shock, he initially thematizes the term psychopathy, which has had a major influence upon the discourse as to whether such disorders should be considered an “illness” and deemed worthy of treatment. The assumption of a psychopathic disposition in war neurotics would make financial compensation pointless because these disorders were declared hereditary, and furthermore the persons concerned were branded as delinquents and criminals. Their disorders were primarily considered a result of a lack of initiative to work and a substandard character. Furthermore, Tümmers analyzes the psychiatric practice of the army hospital in Tübingen during World War II. He arrives at the conclusion that the psychiatrists had considerable flexibility in decision making in the treatment of psychologically damaged soldiers. The psychiatrists used their professional authority for the benefit of their patients – largely independent from the overarching demands of the army and the ideological doctrines of the NS leadership. These findings underline firstly the necessity to scrutinize the daily treatment regimen in addition to the theoretical methodology of scientific elites and the field of military psychiatry, and secondly, that all psychiatrists should not be considered a homogenous group that acted against the patients’ welfare to serve political interests.

Tümmers’ exploration into German military psychiatry is followed by the articles by Hans Pols and Gerald N. Grob that complement each other thematically. The aim, as already pointed out in the introduction, is a comparison between German and American military psychiatry. American military psychiatry underwent a complete reorganization in 1942/43 because of the US military intervention in Tunisia. After the attempt to remove the mentally labile turned out to be disastrous for military operations (11% unfit for service, p. 132; up to 35% losses due to psychotic breakdowns, p. 134), US psychiatry adopted psychotherapeutic methods developed by Roy R. Grinker and John P. Spiegel. Unfortunately, however, no explicit point of comparison is made between the German and American military psychiatry.

This volume concludes with Bram Enning and Helen Grevers, who focus on the post war treatment of those Dutch citizens who collaborated with the German occupiers during the war. They analyze selected documents of the so-called „Special Jurisdiction“ concerning cases of voluntary membership in the Armed-SS. Similar to other political prisoners these people were to be judged under special consideration of the circumstances by their actions and their mental history. The psychiatric experts testifying in court, who often had to judge whether a delinquent could be held responsible for his actions, sometimes attested to his „mental incapacity“. The psychiatrists stated that such incapacities were also to be found with members of the Dutch resistance. Enning and Grevers‘ contribution not only points to the important topic of coming to terms with the consequences of war in a post war society, but also to the role of the courts as important institutions in dealing with this all encompassing societal process.

As it has already become apparent, this volume addresses a host of different aspects surrounding the theme: Psychiatry and War. The essays differ considerably – some are summaries, some are based on a broad analysis of the sources – and they are sometimes positioned without a relationship to one another. As a reader, one misses more sharply formulated overarching questions; posing these in the introduction would have helped to forge connections among the diverse subtopics discussed in the book.

_______________________________

Stephanie Neuner is a historian working at the Deutsches Hygiene-Museum Dresden, Germany. She studied history and politics at the Ludwig-Maximilians-University Munich and Edinburgh University. Her research interests focus on the cultural history of psychiatry. Her forthcoming book, Politik und Psychiatrie. Die staatliche Versorgung psychisch Kriegsbeschädigter in Deutschland 1920-39 (Vandenhoeck & Ruprecht 2011) deals with compensation policies towards psychologically disabled veterans of WWI in the Weimar Republic and the Nazi State.

Book Annoucement – Les frontières du délire : écrivains et fous au temps des avants-gardes

Anouck Cape recently published her revised PhD.

La folie, comprise comme un fantasme culturel modelé par la psychiatrie comme par la littérature, a été fondatrice dans les discours et les pratiques textuelles des écrivains d’avant-garde. Elle constitue un fil directeur permettant d’observer de près l’une des mutations culturelles majeures de la première moitié du XXe siècle, qui voit le fou devenir la figure privilégiée de l’artiste moderne. Ce livre retrace l’histoire d’un bouleversement des valeurs, d’un déplacement de frontière entre littéraire et pathologique à l’issue duquel jugements de goût et normes de littérarité se sont trouvés profondément modifiés.

The shifting locus of mental health care. A comparison between France and England

Programme (17 juin 2011)

8h30-9h00 Accueil / Café

  • 9h00 – 9h15 : Mot  d’accueil – Gérard Massé, CH Sainte-Anne
  • Présentation de l’Axe 2 “ Santé et Société” de la MSH Paris Nord – Samuel Lézé, Centre Norbert Elias (ENS Lyon – CNRS – EHESS)
  • 9h15- 9h30      Introduction générale – Emilie Courtin, GSPE-Prisme / London School of Economics et Benoît Eyraud, LARHRA- ENS Lyon / CEMS-EHESS

9h30-12h30 Première session : L’institution psychiatrique à l’épreuve des politiques publiques / Psychiatric Institutions challenged by Public Policies

9h30-09h50    L’hospitalisalisation psychiatrique dans son contexte français
François Chapireau – Psychiatre des hôpitaux honoraire et responsable du Département d’Information Médicale de l’ASM13

09h50 – 10h10 Hors secteur. Maladie mentale, inadaptation et handicap en France dans les années 1960 et 1970
Nicolas Henckes – Chargé de Recherche CNRS, CERMES3 

10h10 – 10h30 La désinstitutionalisation sous l’œil du géographe : regards croisés France-Angleterre
Magali Coldefy – Chargée de Recherche IRDES et chercheure associée UMR Géographie-Cités, Paris 1

10h30- 11h10  Discussion puis débat avec la salle
Serge Kannas  – Praticien Hospitalier, Ancien Chef de service et coordinateur de la MNASM

11h10 – 11h20 Pause

11h20-11h40 Mental health difficulties: have these become a professional responsibility by necessity or by contention?
Hugh Middleton – Professeur Associé, Université de Nottingham et Psychiatre honoraire au Nottinghamshire Healthcare  NHS Trust

11h40-12h00   L’usager au centre du soin ? Le passage à la contrainte hors de l’hôpital dans l’économie des interventions psychiatriques
Delphine Moreau – Doctorante, GSPM-IMM-EHESS.

12h00-12h30 Discussion puis débat avec la salle :
Yannis Gansel Chef de Clinique, UCB Lyon 1 et doctorant à l’IRIS-EHESS

14h- 16h00 Seconde session : Des marges de manœuvre dans les usages des dispositifs de santé mentale / What latitude in the use of mental health care facilities?

14h00-14h20 Housing services for people with mental health problems in England
Marya Saidi – Doctorante, PSSRU, LSE Health and Social Care, London School of Economics

14h20-14h40   La place des jeunes adultes dans la gestion partagée des troubles : un rapport pouvoir/engagement au rythme des phases de la maladie et du parcours de vie
Audrey Parron – ATER et Doctorante, LISST-CERS/UTM

14h40-15h10 Discussion puis débat avec la salle
Philippe Léveque – Psychiatre et Chef de service, CH Arras
Françoise Champion – Chargée de Recherche CNRS, CERMES 3

15h10 -15h30  Les usages de la psychiatrie d’urgence: réponses subjectives et sociales au mouvement de deshospitalisation
Jérôme Thomas – Post-Doctorant, UMR 5206 “TRIANGLE”, Lyon 2

15h30-15h50 Mental health and the café as affective community space
Jo Warner – Maîtresse de Conférences, Université de Kent

15h50-16h20 – Discussion puis débat avec la salle
Discutant à confirmer

16h20-16h30  Pause

16h30-18h30 – Troisième session : La place et le rôle des usagers dans les recompositions du champ de la santé mentale / The part of mental health services users in the re-forming of mental health services

16h30-17h00 – Discours d’introduction de la session
Diana Rose – Directrice de Recherche, Institute of Psychiatry, King’s College London

17h00-18h30 – Table ronde et débat avec la salle
Modérée par Livia Velpry – Maîtresse de Conférences, Université Paris 8 et CERMES 3

  • Anne-Laure Donskoy – Usager-Chercheure et Consultante, Bristol
  • Julien Grard – Doctorant à l’IRIS-EHESS, Animateur du GEM « la Belle Journée »
  • Emmanuelle Jouet – Chargée de Recherche, CH Maison Blanche
  • Hugh Middleton – Professeur Associé à l’Université de Nottingham et Psychiatre honoraire au Nottinghashire Healthcare  NHS Trust
  • Pauline Rhenter-Guéranger – Chargée de Recherche, CCOMS, Lille
  • Sabine Visintainer, formatrice à l’Arfrips
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