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!