Announcement: Course Syllabi for the History of Madness and Psychiatry

With the start of the fall/winter university semester on the horizon in the United States and Europe, H-Madness will be hosting a series of posts featuring course syllabi in field of the history of madness, mental health, and psychiatry.   During the last week of August/first week of September, H-Madness will be posting syllabi from a number of universities and colleges, along with comments by their instructors.  Gareth Evans, Andreas Killen, Paul Lerner, Elizabeth Lunbeck, and Mark Micale, among others, will be sharing their course syllabi and their thoughts about teaching courses in the field.

The editors at H-Madness welcome your input as well. If you teach a course that deals with the history of madness, mental health, and/or psychiatry and are interested in sharing your syllabus and thoughts about teaching, please contact editor Greg Eghigian (gae2@psu.edu).  We would be delighted to post them and include you in the series.

We hope to make this a regular feature of H-Madness.  In addition, we plan to set up an archive of course syllabi that can serve as a resource for those interested in developing similar courses at their institutions.

The Editors

New Issue of Gesnerus

The most recent issue of Gesnerus contains several articles related to the history of psychiatry.

Titles, authors and abstracts are listed below.

“Une stabilisation difficile. La chlorpromazine dans les années 1950 en Belgique” by Benoît Majerus (Université libre de Bruxelles)

Through a Belgian case study the article tries to trace the gradual stabilisation of chlorpromazine as an antipsychotic in the 1950s. By varying ranges and angles of approach it shows the heterogeneity of actors involved and the semantic bricolage that accompany the marketing of the first antipsychotic. Far from being a revolution, the presence of Largactil® in psychiatric practice is rather characterised by integration into a wider range of medicines and sinuous searching to give sense to this new drug.

“Psychische Ereignisse – organische Interpretationen: Traumakonzepte in der deutschen Psychiatrie seit 1889″ by Ruth Kloocke (Unit for Social and Community Psychiatry, Newham Centre for Mental Health), Heinz-Peter Schmiedebach (Institut für Geschichte und Ethik der Medizin, Universitätsklinikum Hamburg-Eppendorf) and Stefan Priebe (Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Universitätsmedizin Berlin)

This paper examines the debate on psychological trauma in German psychiatry since 1889. A content analysis of five leading German psychiatric journals between 1889 and 2005 is realised. An organic concept of psychological trauma has been prominent in the professional debate until today. Psychiatrists frequently referred to physical traumatisation, constitutional factors and genetic predisposition, exogenous reaction types according to Bonhoeffer, and to biological markers in the context of the PTSD concept. The biological tradition in German psychiatry resulted in a specific adoption of concepts on psychological trauma. However, integrating various models of psychological trauma into a psychiatric tradition focusing on a biological model proved to be difficult and inconsistent.

Review – Daniel Beer, Renovating Russia: The Human Sciences and the Fate of Liberal Modernity, 1880-1930. Ithaca: Cornell University Press, 2008

In his book “Renovating Russia: The Human Sciences and the Fate of Liberal Modernity, 1880-1930,” Daniel Beer argues that Russian psychiatrists and criminologists at the turn of the twentieth century, like their Western European counterparts, were deeply engaged in trying to explain social problems as functions of mental illness, hereditary ‘degeneration,’ and the inherently unequal ability of different individuals to use reason.[i] Beer shows how Russian medical experts used these concepts to place Russia within a broader framework of modernization theory while at the same time explaining Russia’s particular crises in the wake of the emancipation of the serfs and the onset of industrialization. By studying how Russians developed these ideas, Beer claims, we gain a new understanding of Russian liberalism and of the outcome of the Bolshevik revolution.

Beer finds that Russians writing about mental illness and criminality in the 1890s and early 1900s became increasingly pessimistic about the health of the nation. They believed that hereditary defects were rampant, probably acquired under the influence of the harmful policies of imperial Russia, and that these defects were the causes of alarming rates of mental illness, immoral behavior, and criminality. Most Russians were simply incapable of normal, rational self-control. For Russian liberals, the political implications of this were troubling: was their hoped-for government of laws possible or even desirable if Russians were not really rational actors?

Beer’s contribution here is to challenge the idea that ideals of “liberal modernity” in Russia were at odds with the illiberal policies of the Bolsheviks.[ii] He argues that medical experts helped Russian liberals develop a rationale for decidedly illiberal policies, and that these policies were perfectly in keeping with many of the goals and values of the Bolsheviks. By the 1920s, liberal Russian medical experts had come to believe that the nation’s collective health would need to be “renovated” before Russians would be ready for equal rights under the law. For now, medical experts would evaluate deviants and criminals and sentence them, not according to their actions, but according to how much of a threat their personal biological condition posed to society. For Beer, “liberal modernity” was not a path never taken, it was a path that was taken, and it was one of the causes (necessary, if not sufficient) of Stalin’s Gulag (p. 204).

Beer focuses his study on the way in which Russian medical experts used biological and epidemiological thinking to explain social problems. Russia’s industrialization and urbanization in the late nineteenth century was accompanied by pervasive anxiety about social change. Medical experts, Beer argues, provided the educated public with an important set of concepts and categories that helped them interpret the lurid stories of crime that filled their newspapers. The consensus by the 1880s was that individuals could acquire mental illness or immoral behaviors under the influence of a bad environment, then pass them on to their children. Over several generations, the accumulation of this “degenerate” heredity would lead to serious mental illness and eventually produce a nation of sterile lunatics. Centuries of serfdom had already infected the peasant population, making them weak willed and prone to mental illness. The harsh conditions of the new factories and tenements threatened to do even more serious damage. These problems, experts explained, could best be understood as biological indicators of deep social pathologies. By studying them, Russians could gain an understanding of their fundamental causes and how to solve them.

Searching for the roots of Russia’s problems led to an obvious culprit: the Tsarist regime. For some, the medical analogy suggested that political revolution was the only logical “cure” to what ailed Russian society. In 1905, however, educated Russians got to see revolution close up, and many were horrified. Urban crowds attacked government officials, bands of peasants burnt manor houses, and reports poured in of unprecedented levels of criminality and mental illness. Medical experts concluded that revolution itself could trigger an epidemic of latent deviance in apparently normal people. Worse, children conceived in this period of upheaval might inherit serious hereditary defects. If the population were to be ‘renovated,’ it would have to happen through reform, not revolution.

After 1905, Beer finds, medical experts were fatalistic about the prospects for liberal government in Russia. They concluded that most Russians reflexively imitated the behavior of others. Like a contagious laugh, criminality or immorality could spread through a crowd or a city. If people were not in control of themselves, could they be allowed the freedom to pursue their own self-interest?[iii] One influential Moscow psychiatrist, Nikolai Bazhenov, went so far as to argue that science had proven that Russia could only be an oligarchy, where the “unsuggestible” members of the population ruled over the “suggestible” (p. 162).

After 1917, psychiatrists and criminologists adapted quickly to the new regime, most notably by finding employment under the aegis of the organization that would become the NKVD, and they helped create a “social defense” approach to deviance in Stalin’s Soviet Union. They argued that deviants were clearly diseased and dangerous to society. They would need to be removed from society before they could infect it with their behaviors, their opposition political views, or their heredity. Labor camps were seen as a useful tool for isolation and rehabilitation. As one psychiatrist wrote in 1929, the task was one of “securing the life and work of the healthy by means of isolating the sick, by means of filtering out those who have not adapted to particular labor processes, particular living conditions, a prophylactic renovation of the population” This was, Beer, writes, “a theoretical sanction to the burgeoning Soviet gulag” (pp. 198-199).

Beer’s argument is highly suggestive, and if proven would help explain the findings of Amir Weiner and others who have argued that Soviet Marxism had a strongly “biologizing” tendency.[iv] But Beer does not substantiate his broader claims about the impact that medical discourse had on non-specialists. Did educated Russians really adopt biomedical concepts to help themselves understand their society? Beer does not offer an analysis of the popular press, private letters, or any other source base that might corroborate his claim that biomedical thinking informed Russian liberal thought. Similarly, he does not analyze the writing of Gulag planners or Bolshevik ideologues.

The status in the Soviet Union of criminology, eugenics, and psychiatry is particularly problematic for Beer’s argument. As he points out, criminology and eugenics were banned in the USSR at almost exactly the moment that the Gulag was being created. Beer calls this “paradoxical,” and argues that the closures were the result of institutional in-fighting, not any deeper antagonism between Bolshevik ideology and biomedical theory (pp. 199-200). In any case, he claims, biomedical discourse had already produced ways of thinking that continued to shape how the Bolsheviks understood social problems and their solutions. Is this true? It may be, though the published collections of Gulag documents do not obviously suggest it.[v] Reading Beer’s book, I found myself thinking that the more likely case was that the Bolshevik creators and operators of the Gulag just didn’t care whether or not these scientists supported Gulag-like camps, and that they were perfectly capable of arriving at the idea of labor camps without psychiatrists to provide a rationale.[vi] Just because the authors of this biomedical discourse believed their ideas had great relevance to the world in which they lived does not mean that they were really influential outside the charmed circle of academic journals.

These objections should not take away from the value of Beer’s account. He has alerted us to a powerful cross-disciplinary discussion about the relationship between individual agency, biological determinism, and social environment. His work points to important new avenues for future research and provides a very useful basis of comparison for scholars who wish to situate Russia within a larger history of European biopolitics.

Benjamin Zajicek (Towson University)


[i] Beer’s work should be read alongside that of scholars who have studied this discourse in the context of Western Europe, particularly Daniel Pick, Faces of Degeneration: A European Disorder c. 1848-c.1918 (Cambridge: Cambridge University Press, 1989); Robert A. Nye, Crime, Madness, and Politics in Modern France: The Medical Concept of National Decline (Princeton: Princeton University Press, 1984); and Ruth Harris, Murders and Madness: Medicine, Law, and Society in the Fin de Siècle (Oxford: Oxford University Press, 1989). For a comparative overview of the literature on biopolitics in the USSR and Nazi Germany, see David L. Hoffmann and Annette F. Timm, “Utopian Biopolitics: Reproductive Policies, Gender Roles, and Sexuality in Nazi Germany and the Soviet Union,” in Beyond Totalitarianism: Stalinism and Nazism Compared, ed. Michael Geyer and Sheila Fitzpatrick (New York, N.Y.: Cambridge University Press, 2009), 87-129.

[ii] Beer particularly sees his work as challenging an argument made by Laura Engelstein in her 1993 article, “Combined Underdevelopment,” American Historical Review, no. 2 (April 1993): 338-353. In that article, Engelstein argues that the disciplinary regime that Foucault found in Western Europe did not exist in Soviet Russia. Western European states, the USSR did not claim to impartially defend the rights of the individual while surreptitiously allowing the human sciences to violate the spirit of that claim by disciplining individuals. As a result, professionals did not operate as autonomous agents applying disciplining individuals in a way that was at odds with the principles of equality under the law. Instead, professionals simply operated as coercive agents of the illiberal state. Beer argues that Engelstein is wrong to assume that liberalism had failed because the state did not offer legal protection for individual rights. To the contrary, he claims, by 1918 Russian liberals had decided that Russians were not ready for equal rights. Beer, 16-26.

[iii] Interestingly, Beer finds that Russian authors had developed a literature on crowd psychology that significantly predated the better known work of Western European authors like le Bon. Beer, 147.

[iv] Amir Weiner, “Nature, Nurture, and Memory in a Socialist Utopia: Delineating the Soviet Socio-Ethnic Body in the Age of Socialism,” The American Historical Review 104, no. 4 (Oct. 1999): 1114-55.

[v] See, for instance, the extensive collection of documents published in O. V. Khlevniuk, The History of the Gulag: From Collectivization to the Great Terror, Annals of Communism (New Haven: Yale University Press, 2004).

[vi] An area of Soviet policy where it seems more likely that Beer’s bio-social discourse had an important or even decisive influence was in developing the Soviet policing concept of “socially harmful elements” which helped radicalize the search for enemies of the state in 1937. Historians Paul Hagenloh and David Shearer have shown how Soviet police developed social defense tactics to deal with recidivist criminals in the early 1930s. They argue that these tactics were later deployed to enable the “mass operations” that transformed state terror in the 1930s into the “Great Terror” of 1937-38. A concise version of this thesis can be found in Paul M. Hagenloh, “Socially Harmful Elements’ and the Great Terror,” in Stalinism: New Directions, ed. Sheila Fitzpatrick (London & New York: Routledge, 2000), 286-308. See also Paul Hagenloh, Stalin’s Police: Public Order and Mass Repression in the USSR, 1926-1941 (Washington, D.C.: Johns Hopkins University Press, 2009) and David R. Shearer, Policing Stalin’s Socialism: Repression and Social Order in the Soviet Union, 1924-1953 (New Haven: Yale University Press, 2009).

Review – Forbidden Places: Online Photography Exhibit of the New Jersey State Hospital for the Insane

Forbidden Places is an on-line collection of photographs by an artist named Slyv, who describes his passion for urban exploration as developing out of childhood trips to empty factories; he suggests that “abandoned and futureless places are part of our cultural heritage.” And he urges browsers to investigate and document these places before they deteriorate further or disappear altogether. The New Jersey State Hospital near Morristown, New Jersey, known as Greystone, is among the decrepit sites he has recently surveyed.

The photo essay begins with historical postcards of Greystone, and continues with some compelling and original images of the interior of the hospital.  One of the best shows a corridor, halfway below grade, with piles of clean white snow beneath cracked windows, the dark silhouette of a wheelchair, and a menacing grid of overhead pipes.  The most successful photographs are the ones in which he lets the space speak for itself: when he tilts the camera to create false drama, the overall effect is weaker.  There’s enough drama in a vacant psychiatric hospital without the artist’s contrivances.

There are several evocative photos on this website, and these might in turn pique the interest of folks who know little about the history of asylums, the treatment of the mentally ill in the nineteenth century, or the preservation of old buildings.  This is a potentially hip way for historians to reach non-academics.

Architectural historians, like myself, sometimes complain that our students sit motionless behind their computers and iphones, encountering culture as two-dimensional fare inside a blinking screen.  As a teacher, I even devise special assignments that force my students to walk around our city looking at actual structures.  So I should be glad: here is a young artist and his young audience.  They are adventurous and curious, and they even go outside.  (I am guessing Slyv’s age based on one photograph of his naked back and the audience’s age based on the language in the comments.)

So while I hate playing the schoolmarm (“kids today!”), I can’t wholeheartedly support this project, particularly the asylums.  While the artist claims he does not recommend trespassing, the comments are sprinkled with barely literate questions that amount to “how do I get past the cops?”   The other explorers are attracted to Greystone because of its creepy, forbidden quality, which apparently equates to counter-culture fun.  Is this generation of people so doused in vampire blood that sadness is a game to them; does morbidity bounce off them?

Curiosity about the patients doesn’t erase stigma; it perpetuates stigma. Sneaking around asylums diminishes the lived experience of the patients who suffered in there.  It’s not OK to lie in someone else’s coffin, or wear someone else’s straitjacket.

If readers of H-Madness are interested in a serious and deeply-sensitive artist’s approach to state hospitals, they will appreciate Asylum by Christopher Payne (MIT Press, 2009), a beautifully produced book of photographs with a foreword by Oliver Sacks.  Payne is an outstanding photographer who knows the conflicted and troubled history of this subject well.  (He also got permission for every site visit.)

Carla Yanni is Professor of Art History at Rutgers, The State University of New Jersey.  She studies the relationships among architecture, science, and medicine from the beginning of the nineteenth century to the present. The Architecture of Madness: Insane Asylums in the United States, was published by the University of Minnesota Press in spring 2007.  In 2000, Johns Hopkins University Press published Nature’s Museums: Victorian Science and the Architecture of Display.

Fall Colloquium on the History of Psychiatry and Medicine (Harvard)

Department of Postgraduate and Continuing Education, McLean Hospital

And

Center for the History of Medicine, Francis A. Countway Library of Medicine

present

COLLOQUIUM ON THE HISTORY OF PSYCHIATRY AND MEDICINE

David G. Satin, M.D., DLFAPA Director

Open to students of history and those valuing a historical perspective on their professions.

———-Fall, 2010———-

September 30

NOTE NEW DATE, LOCATION, TOPIC

“How Physician Healers Turn to Murder and Genocide:  What We Know About the Making of a Torturer From Nazi Germany to Abu Ghraib”

Michael A.Grodin, M.D.: Director, Project on Medicine and the Holocaust Elie Wiesel Center for Judaic Studies, Boston University; Professor of Bioethics and Human Rights, Boston University School of Public Health; Professor of Family Medicine and Psychiatry, Boston University School of Medicine

(location:  Ballard Room)

October 21

“Reforming Mental Health Via Hollywood:  ‘The Snake Pit’ (1948) and Its Audiences”

Benjamin Harris, Ph.D.: Professor of Psychology and Affiliate Professor of History, University of New Hampshire

(location: Minot Room)

November 18

“German-speaking Psychiatrist and Neurologist Émigrés to the U.S. After WWII”

Frank W. Stahnisch: Associate Professor, AMF/Hannah Professorship in the History of Medicine & Health Care, Department of Community Health Sciences and Department of History, University of Calgary, Member of the Hotchkiss Brain Institute

(location: Minot Room)

December 16

“Asylum:  Inside the Closed World of State Mental Hospitals”

Chris Payne

(location: Minot Room)

4:00 P.M.—5:30 P.M.

room as indicated, fifth floor, Countway Library of Medicine

Harvard Medical Area

For further information contact David G. Satin, M.D., Colloquium Director,

phone/fax 617-332-0032, e-mail:  david_satin@hms.harvard.edu

One Woman’s Encounters With Psychoanalysis

New York Times contributing writer Daphne Merkin has just published a piece in the New York Times magazine, chronicling her encounters with numerous psychotherapists – primarily psychoanalysts – over four and a half decades.  As Merkin puts it,

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive. Projection. Repression. Acting out. Defenses. Secondary compensation. Transference. Even in these quick-fix, medicated times, when people are more likely to look to Wellbutrin and life coaches than to the mystique-surrounded, intangible promise of psychoanalysis, these words speak to me with all the charged power of poetry, scattering light into opaque depths, interpreting that which lies beneath awareness. Whether they do so rightly or wrongly is almost beside the point.

Does Alcoholics Anonymous Work? How Would We Know?

Since its founding in the U.S. in the 1930s, Alcoholics Anonymous (AA) has proven to enjoy the support of a wide range of individuals, authorities, professionals, and civic organizations.  According to AA, it was estimated in 2007 that worldwide there were over 116,000 AA groups, with more than 2 million members.  Yet for all its popularity, relatively little is known about how and the extent to which AA actually works.  The organization’s insistence on anonymity has made research about members difficult, and estimates of its success rate have ranged wildly, from 5% to 75%.

Wired magazine and the blog neuroanthropology.net offer up two articles, attempting to explain the draw of Alcoholics Anonymous. Brendan I. Koerner’s “Secret of AA: After 75 Years, We Don’t Know How It Works” examines the history of AA in a critical, yet balanced, fashion, discussing both the successes and shortcomings of the group’s approach. Mark Flanagan’s “Hard Drinkers Meet Soft Science” is interested in addressing the question, “Why do so many science-based medical providers recommend AA?”  His answers: it’s free, it’s convenient, and it comes with passionate anecdotal evidence to support it.

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