Archive for May, 2012

Call for Papers Reminder: Journal of Nervous and Mental Disease

Reminder:  The Journal of Nervous and Mental Disease, the United States’ oldest continuously published independent monthly journal in the field, will celebrate its 200th volume in 2012. Editor-in-Chief John A. Talbott, M.D., has announced that the anniversary issue will be dedicated to the history of psychiatry and neurology.  The deadline has been extended to July 1.  Dr. Tablott encourages submissions from scholars working in the field of the history of psychiatry and mental health to submit their papers for consideration (especially subjects from 1974 to the present) to the journal.

How I Became a Historian of Psychiatry: Gerald Grob

To continue our intellectual biography series, Gerald Grob, the Henry E. Sigerist Professor of the History of Medicine (Emeritus) at Rutgers University and author of various books including The State and the Mentally Ill (1965), From Asylum to Community: Mental Health Policy in Modern America  (1991) andThe Deadly Truth: A History of Disease in America (2002), has kindly agreed to share with us his own trajectory:

Like many American historians, I shared the social democratic ethos that dominated the discipline in the post-World War II decades. I was born in 1931 at the beginning of the Great Depression. My parents were Jews who had migrated from Poland to the United States in order to escape from an environment in which anti-Semitism was endemic and virulent. Married in 1929, they lacked formal education and struggled economically for most of their lives. Yet they instilled in my sister and me an almost naive faith in the redemptive authority of education quite apart from its role in enhancing career opportunities. Their Judaism, poverty, and liberal outlook made then staunch supporters of Franklin Delano Roosevelt’s New Deal.

 

My commitment to the social democratic left was further strengthened during my years at the City College of New York, a bastion of liberal if not radical thinking. The student body included many committed to Marxian ideals, which in their eyes provided an alternative to what appeared to be a rapacious capitalism. Although I was not unsympathetic to campus Marxists, their single-mindedness and hostility to alternative ideas proved unacceptable, and my allegiance remained with the liberal and social democratic left.

 

My faith in a liberal political ideology and its promise of progress, nevertheless, was always tempered by a recognition that human beings were neither completely rational nor moral. Too young to serve in World War II, I was increasingly aware of the horrors of Nazism and the Holocaust. With but a single exception, all of the members of our family who had remained behind in Poland–including my grandfather–were murdered by the Germans. The Holocaust left me with an abiding sense of tragedy and a recognition of human frailty. My approach to history, therefore, reflected contradictory tendencies: a commitment to social democratic principles; a belief in the fallibility of human nature; a faith in the ability of individuals to make genuine choices independent of the forces operating upon them; and hostility to any overarching historical explanations bordering on determinism. Nor was I persuaded that all phenomena were linked or that it was possible to apply all-encompassing theories to human behavior and society.

 

After graduating from City College in 1951, I briefly attended Columbia University, where I received my M.A. in 1952. Through a circuitous route I ended up at Northwestern University and received my Ph.D. in 1958 (interrupted by two years of military service in the army). My dissertation (published in 1961 and entitled Workers and Utopia) dealt with the late nineteenth-century American labor movement, a subject that had interested since my undergraduate days.

 

In 1957 I accepted a teaching position at Clark University in Worcester, Massachusetts. At that time Clark was a small institution but one with a rich intellectual tradition. With a total faculty of no more than about seventy, friendships transcended disciplinary lines. In 1959 a colleague in psychology with extraordinarily broad interests suggested that I set a graduate student to work on a history of an old state mental hospital in Worcester. Upon familiarizing myself with the hospital, I found that it had played a significant role in the history of the care and treatment of persons with severe mental illnesses. I also found that a large mass of manuscript material had survived, including every single patient case history since its opening in 1833 (which by the 1960s exceeded 70,000). By this time I had decided not to pursue my research in labor history, and therefore undertook the task of writing a history of Worcester State Hospital since its opening in 1833.

In retrospect, my decision to pursue research on the history of psychiatry and institutional care was somewhat presumptuous. My knowledge of psychiatry was nonexistent. At the outset I pursued two strategies. The first was to begin a systematic reading of psychiatric works. Secondly, I attended basic training sessions offered to interns at the hospital in order to familiarize myself with clinical practice and institutional life. My book The State and the Mentally Ill: A History of Worcester State Hospital in Massachusetts 1830-1920 was published in 1966. I found that the project presented formidable problems. I was determined not to write a purely local history, but to place the evolution of the hospital within the framework of public policy. My overarching concern, therefore, was with historical context and the ways in which seemingly disparate elements interacted.

The State and the Mentally Ill, though a narrow study, shaped virtually all of my subsequent thinking about the history of institutions and psychiatry. Having learned much from the research on the Worcester hospital, I decided to undertake a national history. Originally I had intended to write a one volume study. Given the sources, this proved impossible, and I ended up by writing a multi-volume study. The first volume (Mental Institutions in America: Social Policy to 1875) appeared in 1973; the second (Mental Illness and American Society 1875-1940) in 1983; the third (From Asylum to Community: Mental Health Policy in Modern America) in 1991. I published a summary volume (The Mad in America: A History of Their Care and Treatment) in 1994. Subsequently I collaborated with Howard H. Goldman in publishing in 2006 The Dilemma of Federal Mental Health Policy: Radical Reform or Incremental Change,? a volume that brought much of the history to the present.

My emphasis has always been on those elements that shaped and modified mental health policy: the changing composition of the population with severe mental; concepts of the etiology and nature of mental illnesses; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, social, and professional attitudes and values. Equally significant, I have tried to show how the structure of the American political system shaped the mental health system.

After working on the history of psychiatry for nearly four decades, my interest began to shift to the history of changing disease patterns. For many years I taught a course on the changing epidemiology of disease. I decided therefore to shift my focus to write about this subject. The result was the publication in 2002 of The Deadly Truth: A History of Disease in America, and in 2010 (with the collaboration of Allan V. Horowitz) Diagnosis, Therapy and Evidence: Conundrums in Modern American Medicine. In these books I hoped to illuminate changing patterns of morbidity and mortality and to reveal the folly of those who suggest that the elimination of disease should be the primary goal of medical science.

In closing I must concede that a series of personal beliefs have clearly shaped my scholarly work. I have never held to the modern belief that human beings mold and control their world in predetermined and predictable ways. This is not in any way to suggest that we are totally powerless to control our destiny. It is only to insist upon both our fallibility and our inability to predict all of the consequences that follow our actions. Nor do I believe that human behavior can be reduced to a set of deterministic or quasi-deterministic laws or generalizations, or that solutions are readily available for all our problems. Tragedy is a recurring theme in human history and defines the parameters of our existence. I have always tried, therefore, to deal sympathetically with our predecessors who grappled–so often in partial and unsuccessful ways as we still do ourselves–with their own distinct problem.

Many thanks to Gerry Grob for sharing this story with us!

Reconstructing What Happened to Phineas Gage

Christian Jarrett, editor/writer over at the informative and entertaining British Psychological Society Research Digest, has just posted a piece on the latest attempt by researchers to reconstruct what happened to Phineas Gage.  Gage, of course, is one of the most famous neurology patients in history.  In 1848, due to an explosion, a large iron rod went through his face and brain, out the top of his head.  Amazingly, Gage survived, living until 1860.  Jarrett looks at a new study using imaging data:

Now Gage’s skull has been analysed yet again. A team of experts, led by John Van Horn, based at the University of California and Harvard Medical School, has used diffusion imaging data, together with anatomical MRI, to try to find out how Gage’s injury affected the connective tissues of his brain. As they explain: ‘while many authors have focused on the gross damage done by the iron to Gage’s frontal cortical grey matter, little consideration has been given to the degree of damage to and destruction of major connections between discretely affected regions and the rest of his brain.’

New Issue – Culture, Medicine, and Psychiatry

A new special issue of Culture, Medicine and Psychiatry devoted to “ethnographies of suicide” is now online and includes the following articles that might be of interest to historians of psychiatry:

Suffering, Frustration, and Anger: Class, Gender and History in Sri Lankan Suicide Stories (Tom Widger)

This paper explores competing stories of suffering, frustration and anger that shape the performance and reception of suicidal behaviours in contemporary Sri Lanka. Drawing from the results of 21 months of ethnographic fieldwork, I show how suicidal acts fit within broader narratives of class and gender experience and expression that draw from contemporary and historical ‘folk’ and ‘state’ discourses. Debates over whether suffering, frustration and anger are legitimate socio-effective states to exhibit come to determine the kinds of claims and counter-claims that suicidal people on the one hand, and those charged with their treatment and management on the other, can make with regard to the efficacy of suicide as a means of social action. Through such debates—not only what it means to be suicidal in Sri Lanka but also what it means to be middle class or working class, male or female, etc. are made and remade anew.

Postcolonial Suicide Among Inuit in Arctic Canada (Michael J. Kral)

Indigenous youth suicide incidence is high globally, and mostly involves young males. However, the Inuit of Arctic Canada have a suicide rate that is among the highest in the world (and ten times that for the rest of Canada). The author suggests that suicide increase has emerged because of changes stemming in part from the Canadian government era in the Arctic in the 1950s and 1960s. The effects of government intervention dramatically affected kin relations, roles, and responsibilities, and affinal/romantic relationships. Suicide is embedded in these relationships. The author also discusses the polarization between psychiatric and indigenous/community methods of healing, demonstrating that government-based intervention approaches to mental health are not working well, and traditional cultural healing practices often take place outside of the mainstream clinics in these communities. The main questions of the paper are: Who should control suicide prevention? What is the best knowledge base for suicide prevention?

Mad, Bad or Heroic? Gender, Identity and Accountability in Lay Portrayals of Suicide in Late Twentieth-Century England (Christabel Owens and Helen Lambert)

Suicide research has relied heavily on the psychological autopsy method, which uses interviews with the bereaved to ascertain the mental health status of the deceased prior to death. The resulting data are typically interpreted within a clinical diagnostic framework, which reinforces psychiatric assumptions concerning the ubiquity of mental illness amongst those who take their own lives. The ways in which informants reconstruct the past and the meanings they attach to events preceding the suicide are rarely examined. This paper uses qualitative methods to analyse the narratives given by bereaved people in an English psychological autopsy study, in order to understand how they made sense of a family member’s suicide. Some clear differences between the portrayal of male and female suicides emerged. The paper discusses the gendering of agency and accountability in relation to the differential medicalisation of male and female distress in the UK, and suggests that a preoccupation with mental illness in suicide research may have obscured other culturally normative understandings of self-accomplished death.

For more information and a complete table of contents, click here.

New issue: History of Psychiatry

The June 2012 issue of History of Psychiatry is now online and contains the following articles:

R.D. Laing’s theological hinterland: the contrast between mysticism and communion (Gavin Miller)

Contrasting elements in R.D. Laing’s psychiatry can be traced to two kinds of Christian theology: mystical theology and corporate theology. On one hand, Laing’s mystical theology combined with psychoanalytic theory, to provide a New Age psychotherapeutic account of the recovery of authentic selfhood via metanoia. On the other, his incarnational, corporate theology promoted social inclusion of the mentally ill, particularly via therapeutic communities. For Laing, as for other post-war British Christians, a turn inwards, to mysticism and the sacralization of the self, and a turn outwards, to social and political activism, were ways of negotiating with the decline of traditional Christianity.

Psychiatric case notes: symptoms of mental illness and their attribution at the Maudsley Hospital, 1924–35 (Edgar Jones, Shahina Rahman, and Brian Everitt)

Case notes of patients treated at the Maudsley Hospital during the interwar period provided data about diagnosis, symptoms and beliefs about mental illness. In the absence of effective treatments, patients were investigated in detail in the hope that connections between disease processes might be revealed. We analysed a randomly-selected sample of 700 patients taken equally from 1924, 1928, 1931 and 1935. Eight groups (three representing psychosis and five indicating psychological disorders) were identified on the basis of symptom clusters. Formal diagnosis did not correlate with clusters. Although there was a measure of agreement between patients and doctors about the cause of mental illness, stigma may have inhibited discussion of some themes. Psychiatric diagnosis was informed by symptoms but not determined by them. In an era before classification systems were tested for reliability, diagnosis was fluid, reflecting changing hypotheses about causation, pathology and treatment. Attributions were associated with diagnosis rather than symptoms.

Limited to no responsibility: addiction, alcoholism and the law in modern Germany (Jonathan Lewy)

In Germany, a perpetrator had to be of sound mind to be convicted of a crime throughout the nineteenth and twentieth centuries. The criminal code was clear, but reality was not. From the moment that physicians accepted alcoholism and drug addiction as diseases of mind and body, the question of what to do with alcoholic and addicted criminals troubled legal theorists. How were judges to maintain the balance of justice if, on the one hand, a potential perpetrator chose to be of unsound mind by drinking or using drugs, but on the other, he was sick, unable to control his actions? As this article demonstrates, the legal system was lenient towards inebriated perpetrators as a by-product of the insistence of German doctors that alcoholism and addiction were diseases.

Between phenomenological and community psychiatry: the Comprehending Anthropology of Jürg Zutt (Peter Schönknecht and Tom Dening)

Phenomenological and existential philosophical approaches to mental illness have had great influence on psychiatric research and theory in European psychiatry (Berrios, 1992: 309). Among them, the work of Jürg Zutt (1893–1980), Professor of Psychiatry at University Hospital Frankfurt 1950–63, closely relates to the anthropological psychiatry of Ludwig Binswanger, Victor von Gebsattel and Erwin Straus. Since both anthropological psychiatry and social psychiatry are based on a person-centred approach, it was hypothesized that common roots are to be detected in what is called humanistic psychology. The main finding of the present paper is that there is a strong relationship between Zutt’s concept of Comprehending Anthropology and the biopsychosocial model on which social psychiatry is based. However, it cannot be concluded from the existing evidence that the reform of psychiatric services necessarily resulted from the anthropological approach.

Psychology during the expeditions of the heroic age of Antarctic exploration (HR Guly)

The psychology of Antarctic explorers and groups in Antarctic bases has been much studied in recent years, and current knowledge has been summarized in a review by Palinkas and Suedenfeld (2008). There was no formal psychological research during the heroic age of Antarctic exploration, but a number of the doctors and non-medical personnel on the expeditions were keen observers of the psychological aspects of the expeditions and wrote about them. In this paper, I describe their understanding of the psychology of Antarctic exploration. By comparing this with current knowledge, it is clear that most of what has been found by formal study was known to the explorers of the heroic age.

Psychiatric illness and suicide in the heroic age of Antarctic exploration (HR Guly)

During the heroic age of Antarctic exploration, a number of the early explorers developed psychiatric illness either in the Antarctic or shortly after leaving it. Most of these were psychotic illnesses and stress reactions. At least six explorers committed suicide either in the Antarctic or after their return. These cases are described, and possible reasons for the apparent high incidence of psychiatric disease and suicide are discussed. There are also examples of the possible misuse of psychiatric labels.

Victor Kandinsky (1849–89): a pioneer of modern Russian forensic psychiatry (Vladimir Lerner, Jacob Margolin, and Eliezer Witztum)

The paper describes Victor Kandinsky’s professional achievements within nineteenth-century Russian forensic psychiatry. A thorough review of nineteenth-century Russian psychiatry is presented, followed by a short biographical account of Kandinsky’s personal life. Within the backdrop of Russian forensic psychiatry toward the end of nineteenth century, Kandinsky’s pioneer innovations in psychopathology and classification as well as his contributions to Russian forensic psychiatry are reviewed. These are exemplified by two of his forensic case studies relating to forensic responsibility and malingering, which are included in his famous book ‘On Irresponsibility’.

The issue also contains a comment on Frederic Rowland Marvin’s classic 1874 text ‘The Pathology and Treatment of Mediomania’ by Carlos S Alvarado and Nancy L Zingrone; the full text of Richard Noll’s Dementia praecox, 1886: a new turning point?, as well as book reviews of Waltraud Ernst and Thomas Mueller (eds), Transnational Psychiatries: Social and Cultural Histories of Psychiatry in Comparative Perspective c. 1800–2000; Paul E Stepansky’s Psychoanalysis at the Margins; Alfred I Tauber’s Freud: The Reluctant Philosopher; Jan Goldstein’s Hysteria Complicated by Ecstasy: The Case of Nanette Leroux; and Marco Conci’s Sullivan Revisited – Life and Work: Harry Stack Sullivan’s Relevance for Contemporary Psychiatry, Psychotherapy and Psychoanalysis.

For more information, click here.

Exhibit Review – X-Rays of the Soul: Rorschach and the Projective Test, Harvard University (through June 30).

Jeremy Blatter

“X-Rays of the Soul: Rorschach and the Projective Test,” curated by Marla Eby, Peter Galison, and Rebecca Lemov, is the most recent exhibit to open at the Collection of Historical Scientific Instruments located in the Science Center at Harvard University. The exhibit explores the history of the projective test, not only as a diagnostic tool in clinical psychology and psychiatry, but as a widely employed technique in anthropological research and as an important meme and metaphor in popular culture.

Among the many provocative artistic interventions found in this exhibit are four large lenticular reproductions of Rorschach cards. By moving to either side of each lenticular print different features and emphases in the inkblots are revealed. The effect is that as you move from left to right it is as if the inkblot itself is revealing a range of potential interpretations that could land you anywhere along the psychiatric spectrum.

By dedicating one side of the exhibit to inkblot tests and the other to tests like the TAT (Thematic Apperception Test), which rely on more literal and narrative-driven modes of representation, the exhibit highlights two very different approaches to rendering the kind of controlled ambiguity that is the earmark of most projective testing techniques. However, many of the most interesting objects on display are precisely those testing materials which reveal the breakdown of this putatively pure ambiguity. For example, Charles Thompson’s “African American Thematic Apperception Test” (1949) and the anthropological adaptations of the TAT for Tahitians force us to more carefully consider the place of race and culture in the design and practice of projective testing.

“X-Rays of the Soul” is open 9-5:00PM daily in the Science Center at Harvard University and closes June 30.

Jeremy Blatter is a Ph.D. candidate in the History of Science at Harvard University. His research focuses on the history of psychology and the social sciences in the late nineteenth and early twentieth century as well as the intersection of science and visual culture (particularly in the form of film, photography, architecture, advertising, and industrial design). In his dissertation “The Psychotechnics of Everyday Life: Hugo Münsterberg and the Politics of Applied Psychology, 1892-1929,” Jeremy explores the early years of applied psychology and psychotechnics.

About once a month, the UC Davis Disability Studies blog  posts a listing of recently published historical articles about disability (somewhat broadly defined).

This month, the list includes:

Brownlee, Kimberly, “Treatment of the Mentally Ill in Northwest Ohio: The Lucas County Infirmary and Poor Farm and the Toledo State Hospital,” _Northwest Ohio History_ 79(Fall 2011): 1-14.
 
Ferlito, Susanna. “Hysteria’s Upheavals: Emotional Fault Lines in Cristina di Belgiojoso’s Health History,” _Modern Italy_ 17(2)(2012): 157-170.
 
Grimsley-Smith, Melinda. “Revisiting a ‘Demographic Freak’: Irish Asylums and Hidden Hunger,” _Social History of Medicine_ 25(2)(2012): 307-323.
 
Munyi, Chomba Wa. “Past and Present Perceptions Towards Disability: A Historical Perspective,” _Disability Studies Quarterly_ 32(2) (2012): online open access here: http://dsq-sds.org/article/view/3197
 
York, Sarah. “Alienists, Attendants, and the Containment of Suicide in Public Lunatic Asylums, 1845-1890,” _Social History of Medicine_ 25(2)(2012): 324-342.
For more details, click here.
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