happy birthday h-madness

A year ago, we published our first post on historypsychiatry.wordpress.com. Soon, an editorial board was set up and h-madness found its place in the blogosphere. In the last year, we have published 207 posts, this one included. We have had 53 000 page views – the busiest day having been March 17, 2010 when we launched our discussion on DSM-V. We plan on forging ahead and encourage our readers to initiate discussions about our posts through comments. We would also like to thank all the authors of the last year. Here are some statistics (for the geeks out there).

280 readers follow the blog through e-mail notification and 160 through a feed-reader.

Review—PTSD before PTSD. The Politics of War Trauma: The Aftermath of World War II in Eleven European Countries. Editors: Jolande Withuis and Annet Mooij. Amsterdam: Aksant, 2010.

by Hans Pols

By now the story of the origin of Posttraumatic Stress Disorder [PTSD] is fairly well known: the diagnosis was the surprising outcome of an unusual set of political circumstances during the 1970s in the USA. At that time, a somewhat unlikely coalition was formed between psychiatrists treating disgruntled Vietnam veterans, advocates for Holocaust survivors, and representatives of the feminist movement demanding public attention for the long-lasting psychological effect of physical and sexual abuse of women. All three groups had observed similar sets of symptoms in the traumatized individuals under treatment. And in all three groups symptoms at times appeared many years after the original event. For all three groups, the PTSD diagnosis provided a medical recognition of their suffering, opened up avenues for treatment, and presented a justification for compensation claims. Accounts on the origins of PTSD generally emphasize the originality and novelty of the diagnosis. The book under review dispels this notion thoroughly: unusually rich and extensive medical and political debates on the sequelae of extraordinary suffering of World War II took place in many European countries after 1945. Physicians who themselves had experienced deportation and life in Nazi concentration camps played a key role in these debates. In all European countries, the public recognition of these horrifying experiences depended on a variety of social, political, cultural, and medical factors, which all changed over time. The essays in The Politics of War Trauma analyze the unlikely political coalitions that made the recognition of war-related suffering possible, which groups were included and which were excluded, and how changes in medical, social, cultural, and political thinking influenced this process.

Central to the formation of medical theories on the health effects of war as well as their social recognition (in the form of pensions, entitlement to compensation, or health care) were the way European nations came to terms with World War II. Politicians, religious leaders, and other opinion makers were engaged in extensive efforts to frame the memory of the war in ways that positioned themselves (and their nations) favorably and that downplayed culpability, guilt, and collaboration. The collective memory of any war is inherently fraught with myths about widespread and heroic resistance and martyrdom at its core (rather than banal collaboration and innocently looking the other way, which was much more common). These myths consist of more or less deliberate acts of forgetting, falsification, obfuscation, fabrication, and confabulation. In many countries, the ranks of the Resistance swelled enormously immediately after the armistice. At the same time government bureaucracies and the armed forces were symbolically purged of a small number of collaborators (while most others remained in their position). Presenting a favorable image of one’s past during the war was particularly necessary for those European countries which sought to hide their official allegiance to Nazi Germany and many acts of collaboration (Austria, Italy, Vichy France, Denmark, and Spain (which is unfortunately missing in this volume)). Austria, as the alleged first victim of Nazi aggression, has always denied any responsibility for its complicity in Nazi atrocities. It referred claims from Austrian survivors of concentration camps to Germany while it paid pensions to all Austrians who had served in the German Wehrmacht or SS Korps. Denmark celebrated a very small and select group of resistance fighters to deflect attention from its less than admirable war record (it surrendered without a fight and its government accommodated the Germans without too much friction). Luxembourg made much of the “pupils of the nation,” a group of orphaned children of killed resistance fighters.

Questions of which individuals were entitled to compensation or war pensions (for suffering, lost income, incapacity, or health problems) were resolved within the context of these sets of narratives to remember the war, commemorate its heroes, and vilify the villains. According to many, resistance fighters and soldiers who resisted the invading Nazi powers deserved recognition. Yet many post-war regimes were loath to acknowledge the contribution of communist resistance fighters and were not eager to include them as potential recipients of pensions. In France, for example, an influential bureaucrat was proud that he personally had made sure that 75% of applications by Communists were rejected (p. 89). In Belgium, Flemish Catholics (who had not been unsympathetic to the Nazis) were upset that the proposed pension legislation would benefit more Walloon then Flemish individuals (because there had been far more Walloon resistance fighters) and insisted on emendations. In West Germany, communist resistance fighters were written out of the historical record and hardly received any recognition and compensation. In East Germany, the opposite happened: only those individuals who had furthered the international interests of the Soviet Union were honored. All the others had to wait until after the wall came down.

Questions remained about individuals who were conscripted to work in German ammunitions factories. They were forced to become collaborators and did not fit the image of heroic resistance fighters. Recognition for them was slow in the coming. During the first two decades after World War II, Jews returning from the concentration camps found it very difficult to get any claims acknowledged (the few who survived the extermination camps felt positively unwelcome upon their return). Before World War II, many Jews did not have the nationality of the country they were living in—which initially excluded them from any consideration for compensation. Veterans’ organizations and other pressure groups were essential in formulating the terms under which recognition for the traumas of war could be gained—conscripted workers had to form their own associations to make their demands known before they were recognized. Until 1965, most countries emphasized the resistance when remembering the war. More recently, the Holocaust and the fate of European Jews has become central to the recollection of the war. That shift had far-reaching consequences for bureaucratic recognition and compensation regimes.

It is one thing for post-war governments to outline who is entitled to compensation and pensions and what conditions have to be met to receive these. It is quite another thing how these rules were interpreted and applied by faceless bureaucrats. And here some striking events occurred. A Jewish Auschwitz survivor, for example, was repeatedly asked by Italian bureaucrats for the medical records during her time there to substantiate that her current incapacity was related to her war-time experiences. I already mentioned the pride of a French bureaucrat in making sure Communists would not receive any compensation. In Germany and Austria, former Nazi physicians often wrote dismissive medical reports of Jewish concentration camp inmates. Laws formulated with the best intentions meant little in the face of bureaucratic obstructionism, which was the exception rather than the rule.

Summarizing the many points that are richly documented in this volume: the cleansing (or whitewashing) of national reputations, the activities of various pressure groups, and the evolving state of medical knowledge contributed to the recognition of war as trauma which constituted grounds for recognition, support, and compensation. European physicians had already formulated the diagnosis the KZ-syndrome (KZ refers to Konzentrationslager, German for concentration camp). When PTSD arrived in 1980, it became yet another element in these discussions without fundamentally altering them. These discussions accelerated in the 1970s. At that time, historical perspectives on the war years became considerably more nuanced while the number of individuals claiming war-related impairments did not diminish, as had been widely expected, but only increased. In the same decade, attention to the fate of the European Jews increased. No longer were the heroic fighters of the underground resistance central to the recollection of the war but the horrifying images of the extermination camps. It appears that a greater acceptance of a psychological approach to life problems, accompanied by a greater acceptance of the public expression of emotions, was a factor in the increase in the number of people who claimed to suffer from war-related trauma. In addition, it seems that the waning of the Cold War and the lesser relevance of a number of national myths about heroes and villains during the war were important factors as well.

Interestingly, the distinction between organic versus psychological disorder, so central in many histories of psychiatry and in psychiatric discussions today, appears to be more or less irrelevant in the medical discussions covered in this book. Critical instead was the issue of causality: could one prove that one’s current level of incapacity was related one’s war-time experiences. This issue became more difficult to assess as the years passed by. Yet, in some countries and for some categories of individuals (those who spent more than 6 months in prison or concentration camps, for example), this causality was assumed; in other countries the burden of proof was with the compensation authorities (that is, only if they could prove that reasonable grounds existed that an applicant’s current condition was not related to the war could compensation be refused). Whether complaints or incapacity were purely psychological or based on physical injury was hardly important. This makes the approach originally espoused by the editors of the volume (to trace the history of the recognition of psychiatric complaints related to World War II) somewhat irrelevant—but it, correctly in my opinion, broadens that question to include a variety of unexplained medical symptoms related to war experiences.

Hans Pols is senior lecturer at the Unit for History and Philosophy of Science at the University of Sydney. He is interested in the history of psychiatry and the mental hygiene movement in North America and Europe, psychiatric war syndromes, and colonial psychiatry, in particular in the Dutch East Indies.

Journée d’étude – L’expertise psychiatrique, une source pour les sciences sociales ?

Mercredi 19 janvier 2011
Université de Toulouse II-Le Mirail
Maison de la Recherche, Salle D31, 9h-17h

Journée dʼétude organisée par Sylvie Chaperon (Historienne, MC HDR, Université Toulouse II-Le Mirail) et Sébastien Saetta (Sociologue, Doctorant, Université Toulouse II-Le Mirail, Université du Luxembourg)

L’expertise dans le cadre des violences sexuelles sur enfants du XIXe siècle à nos jours – Anne-Claude Ambroise Rendu (historienne, MC HDR, Université de Saint-Quentin en Yvelines)
L’expertise psychiatrique des incestueux au XIXe siècle : un exercice insignifiant ? – Fabienne Giuliani (historienne, doctorante, Université de Paris 1)
Transsexualisme : « Pratique et regard toulousain » – Pierrette Aufière (avocate au barreau de Toulouse)

Les malades mentaux ayant commis des crimes sexuels: entre pénalisation et pathologisation – Caroline Protais (sociologue, doctorante, EHESS)
« Alors, docteur, elle est bonne mon expertise? » – Walter Albardier (Psychiatre, SMPR de Toulouse, CRIAVS Midi Pyrénées, ARTAAS)
Le discours des experts psychiatres dans des cas de « fémicide » – Sébastien Saetta (sociologue, doctorant, Université Toulouse II le Mirail, Université du Luxembourg

Publication des séminaires de Jacques Lacan

Dans une lettre lettre au Champ freudien datée du 9 janvier 2011, Jacques-Alain Miller fait savoir qu’il est en train d’achever la rédaction des séminaires de Jacques Lacan :

Paris, le 9 janvier 2011

Chers collègues et amis,

En ce début de l’année 2011, je vois venir le terme d’un travail qui m’aura depuis longtemps requis. J’achève de rédiger, en effet, ce qui s’appelle, à proprement parler, Le Séminaire de Jacques Lacan – soit les 25 Livres qui vont des Ecrits techniques de Freud au Moment de conclure. Reste encore, pour l’essentiel, à donner le coup de fion à un seul manuscrit, celui du Livre VI, Le Désir et son interprétation, dont j’avais déjà fait paraître jadis six leçons.
En sus de ces 25 Livres, j’ai également établi le texte de quatre autres Séminaires – par ordre chronologique : le Séminaire initial de 1951-52, sur l’Homme-aux-loups, dont subsistent quelques notes d’auditeur ; les Séminaires topologiques, dont ne subsiste que peu, qui furent encore donnés après Le Moment de conclure ; et le Séminaire ultime de 1980, contemporain de la dissolution de son Ecole par Lacan.
Amené depuis un an à consacrer au Séminaire tous les moments dont je pouvais disposer en dehors de ma pratique, j’ai sans doute été moins présent auprès de mes amis, de mes collègues, de vous tous. C’est aussi pourquoi j’avais dû ajourner la reprise de mon cours.
Je donne rendez-vous à ses fidèles auditeurs au même endroit, le mercredi 19 janvier à 14 heures. J’y ferai le point sur la rédaction et la publication du Séminaire, et annoncerai sur quel thème et dans quelles conditions je poursuivrai mon cours en 2011.

Avec mes vœux de bonne année,
Jacques-Alain Miller

On trouvera cette lettre à l’adresse suivante : http://fr.groups.yahoo.com/group/ecf-messager/message/1791

High Society is high impact and high interest

by Katy Barrett

I am writing this review while drinking a cup of coffee in the café of the Wellcome Collection. I would never think of myself as a ‘drug user,’ but the current exhibition High Society reminds us that caffeine is just one of the mind-altering substances which are prevalent in all human societies.

From an opening case of evocative objects – including a Starbucks cup and a Coke can – that draws on the wealth of the Wellcome’s own collections, the exhibition marshals items from ancient Assyrian cuneiform tablets to modern art installations by Richard Hamilton and Keith Coventry to investigate the wide range of ways in which we get ‘high.’ It draws on ceramics, natural specimens, books, prints, paintings, photographs; political advertising, scientific experiments, art installations, interviews to show just how ancient and varied human drug use is. It considers the boundaries between public and private, social and anti-social, legal and illegal. I, in fact, use the term ‘drug’ with trepidation, in case it lead my readers to a culturally-induced ‘pejorative’ understanding of the term which this exhibition by no means endorses.

The opening section ‘A Universal Impulse’ highlights this problem and shows the varying types and functions of drugs in different cultures, considering religious or medical use, and the modern clash between these and international law. Next, ‘From Apothecary to Laboratory’ considers the development from ancient medical plants to modern laboratory drugs and the local and international paths of these. Connected is ‘The Drugs Trade’ section, which reminds us of the ever-present role of British imperial trade and expansion in so much world history, and the importance of the opium trade from India to China in the nineteenth century.

The section on ‘Self-Experimentation’ investigates how scientists and artists have sought to understand what drugs do to the human consciousness and why this varies between individuals; how essentially the results evade complete scientific explanation. The installation by Brion Gysin invites visitors to give themselves a hallucinatory experience. ‘Collective Intoxication’ then considers how drug use is part of social interaction, using and contrasting Western attitudes to more ‘ritualistic’ drug use in other cultures. The final section considers whether drug use is ‘A sin, a crime, a vice, or a disease?’ highlighting how such boundaries change across communities, and have shifted over time along with attitudes to the human mind and body and the relationship between the two.

This exhibition is the Wellcome Collection’s usual high quality and high impact. On a grey Saturday afternoon it was heaving with enthusiastic visitors, showing that the subject is as ‘high’ interest today as the exhibition shows that it has been in the past.

‘High Society’ continues until 27th February 2011 with special events on ‘Drugs in Victorian Britain’ on Friday 11th and Saturday 12th February.

Katy Barrett is a PhD Student on the AHRC-funded research project ‘The Board of Longitude 1714-1828: Science, Innovation and Empire in the Georgian World‘ supervised jointly by the University of Cambridge and the National Maritime Museum, Greenwich, London. She is currently interested in the relationships that were drawn between lunacy and the search for longitude in the early eighteenth century.

New Issue of Medizinhistorisches Journal

A new issue of Medizinhistorisches Journal has been published. It presents, among other things, a piece by Stefan Wulf und Heinz-Peter Schmiedebach entitled Dis/arranged medical histories à la Friedrichsberg. Explorations of foreign patients by multilingual fellow patients in a German asylum about 1900. The abstract reads:

This paper deals with two examples of a particular patient’s activity at the Friedrichsberg Asylum in Hamburg in the beginning of the 20th century. Two multilingual patients assumed the function of interpreters in each case for a foreign fellow patient. They were involved to a great extent in the documentation of the medical histories. Conversations and interrogations carried out by them and recorded by their own hand are passed down in the medical files of their foreign-language fellow patients. After some preliminary remarks about the Friedrichsberg Asylum and its patients, the various activities of patients in the psychiatric institution and the importance of the patients’ manner of speaking for the psychiatric diagnosis, the two cases are described in detail. The patient-interpreters were perceived as border-crossers, as “Figures of the Third”.

CfP: History of Psychology and Psychiatry Postgraduate Conference

Below is a message from Sarah Marks, graduate student at the Wellcome Trust Centre for the History of Medicine at University College London:

Call for Papers
History of Psychology and Psychiatry Postgraduate Conference, 19th March 2011

The Wellcome Trust Centre for the History of Medicine at UCL will host a one day conference for postgraduate students working on the history of psychology and psychiatry. The conference is intended to develop a network of postgraduates across different universities, and to provide a forum for current research in the field.

The conference is open to students from both the UK and abroad. There will be funding available to cover travel costs and refreshments will be provided. We welcome papers on any historical period, and on any geographical region. To see what some of our students are working on, please follow this link: http://www.ucl.ac.uk/histmed/people/research_students

A title and a brief abstract of 150-200 words should be sent to Sarah Marks by the 10th of February (sarah.marks@ucl.ac.uk). Please do not hesitate to contact us with any queries.


%d bloggers like this: