Archive for August, 2012

New book announcement – Journeys into Madness: Mapping Mental Illness in the Austro-Hungarian Empire

Journeys into Madness. Mapping Mental Illness in the Austro-Hungarian Empire

(Berghahn Bo0ks 2012)


Edited by Gemma Blackshaw and Sabine Wieber


For more see here

Retour sur l’Expo


L’histoire parcourt les Expositions Universelles, les kermesses, les Expositions diverses, et, après l’installation du “secteur” psychiatrique, les Expositions “en ville” (dans les bibliothèques, les mairies, les Centres artistiques). Est présenté aussi un retour sur la démarche originale initiée et développée par la SERHEP à Ville-Evrard depuis 2005 : construire et présenter chaque année dans son Musée des « installations artistiques », où les productions de nombreux ateliers en psychiatrie sont des acteurs de premier plan.

Ainsi, l’atelier Extravagances du Club de La Borde, a apporté au Musée de la SERHEP ses robes imaginaires pour l’Exposition sur la Vêture, les animaux fabuleux du Groupe Séquentiel habitèrent la ferme de Ville-Evrard reconstituée au Musée, l’atelier peinture de Champ Libre compléta l’Exposition sur « l’Enfermement et la Liberté » d’une série de tableaux spécialement créés pour l’occasion, etc. Unité ados de Montreuil, Association Présence de Bondy, atelier d’art-thérapie, ateliers de textiles peints, services techniques de l’hôpital, tous apportèrent leur contribution. La question majeure posée par l’installation étant: où est la meilleure place ? La meilleure étant celle qui parle mieux que les mots.

New Book Announcement: Closing the Asylums (George Paulson)

McFarland & Company has just published a new book by George Paulson, Closing the Asylums: Causes and Consequences of the Deinstitutionalization Movement (214 pp. Paperback, $45).

George Paulson is an internationally known neurologist who worked in and about state mental hospitals during the revolutionary movement to close those hospitals. He combines his personal observations with historical scholarship to produce a fresh perspective on a major change in society and medicine.

The press describes the book this way:

One of the most significant medical and social initiatives of the twentieth century was the demolition of the traditional state hospitals that housed most of the mentally ill, and the placement of the patients out into the community. The causes of this deinstitutionalization included both idealism and legal pressures, newly effective medications, the establishment of nursing and group homes, the woeful inadequacy of the aging giant hospitals, and an attitudinal change that emphasized environmental and social factors, not organic ones, as primarily responsible for mental illness.

Though closing the asylums promised more freedom for many, encouraged community acceptance and enhanced outpatient opportunities, there were unintended consequences: increased homelessness, significant prison incarcerations of the mentally ill, inadequate community support or governmental funding. This book is written from the point of view of an academic neurologist who has served 60 years as an employee or consultant in typical state mental institutions in North Carolina and Ohio.

New issue – History of Psychiatry

A new issue of History of Psychiatry is now out and includes the following articles:

“Automatism, Surrealism and the making of French psychopathology: the case of Pierre Janet” (Alexandra Bacopoulos-Viau)

This article deals with the clinical use of ‘automatic writing’ by the French psychologist Pierre Janet at the fin de siècle and its later appropriation by Surrealist poets during the inter-war period. Of special interest are the acknowledged influences of Surrealism’s leading representative. Why did André Breton, in his mythical love affair with Freudianism, systematically silence his indebtedness to the Janetian model of the mind? In order to examine this question we turn to a little-studied theme: Janet’s increasing distance from Spiritism and psychical research. In seeking to establish his new discipline within a medical framework, Janet erected barriers between the psychological sciences and such seemingly ‘extra-scientific’ fields. In so doing, he placed himself at odds with other members of the intellectual community who saw in the automatic manifestations of the mind a source of exalted creativity.

“The nature of King James VI/I’s medical conditions: new approaches to the diagnosis” (Timothy Peters, Peter Garrard, Vijeya Ganesan, and John Stephenson)

It has been claimed that King James VI/I, an antecedent of King George III, suffered from acute porphyria, and that the disease was passed on to George III through his grand-daughter Sophie, mother of George I. The life of James is reviewed and previously-proposed diagnoses are considered. James’s medical history is discussed in detail and, where possible, examined with validated symptom scales. Using an online database of neurological diseases, the authors show that James’s symptomatology is compatible with a diagnosis of Attenuated (mild) Lesch-Nyhan disease; no evidence was found to support a diagnosis of acute porphyria. In addition, there is evidence of associated Asperger traits which may explain some of the King’s unusual behavioural and psycho-social features.

“Erwin Straus and the pathic” (LM Ratnapalan and David Reggio)

This paper details the significance of the ‘pathic’ mode of sensing in the work of Erwin Straus, through a consideration of its origins, etymology, and relationship with the research of his close contemporaries. The ‘pathic’ describes ‘the immediately present, sensually vivid, still pre-conceptual communication we have with appearances’. Straus came to a coherent understanding of its importance through his critique of Pavlov’s laboratory experiments on the conditioned reflex, which he then developed in phenomenological case studies where he further refined his anthropology. Not simply of relevance to the history of phenomenological psychology alone, the ‘pathic’ has an urgent contemporary implication in opposing the rise of what Straus presciently termed ‘mechanomorphic’ interpretations of human behaviour.

“‘Occasionally heard to be answering voices’: aural culture and the ritual of psychiatric audition, 1877–1911” (Kathleen M Brian)

This essay argues that historians will gain a deeper understanding of the nosological ritual and the professionals who enacted it by placing internal developments of late nineteenth-century psychiatry alongside the synchronic rise of the linguistic sciences. Doing so demonstrates that, contrary to historical consensus, what fell out of favour were traditional methods of observation rather than the practice of classification itself. Through an analysis of the aural culture at St Elizabeths Hospital (Washington, DC) between 1877 and 1911 as evidenced by patient case files and diagnostic training manuals, I focus on shifting methods of psychiatric audition as primary sites of professional claims to legitimacy at a time when the specialty was under attack from critics both external and internal.

“English pauper lunatics in the era of the old poor law” (Edgar Miller)

Many of those considered to be insane in the past were regarded as paupers and so came within the ambit of the poor law. Little work has yet been published on the ways in which the poor law dealt with the psychologically disturbed during the era of the old poor law (c.1601–1834). The present paper outlines the old poor law which said very little about madness as a specific problem, with the general implication that they were to be dealt with in the same way as others considered to be in need of relief. It appears that this was generally the case with the exception that the insane were sometimes sent to asylums. They were also liable to be treated as vagrants. Some limitations and problems with primary sources are also noted.

“Freemasonry and psychiatry in Poland” (Tadeusz Nasierowski and Jonathan Britmann)

The history of Freemasonry in Poland is linked with the national independence movement. Masonic organizations supported its ideas, even though they were not always compliant with Masonic ethics. Polish Freemasonry was reborn in 1920, with an important role played by three psychiatrists: Rafał Radziwiłłowicz, Witold Łuniewski and Jan Mazurkiewicz, who were Grand Masters of the Grand National Lodge of Poland. Some of the ethical problems discussed at the lodge sessions were later reflected in their academic and social work. Mazurkiewicz’s work was most crucial to the development of Polish psychiatry. His presentation of the clinical picture of schizophrenia, formulated in the 1930s, was identical with the concept proposed by Andreasen and Crow in the 1980s.

“Extreme fasting among Daoist priestesses of the Tang Dynasty: an old Chinese variant of anorexia nervosa?” (Ann L Lo, LK George Hsu, and Walter Vandereycken)

Austere and prolonged fasting among Shangqing Daoist priestesses (Daogu) of the Tang Dynasty (618–907) occurred as part of a lifestyle practice to achieve a mystical state of afterlife existence, body immortality and residence in the Shangqing heavenly kingdom. These fasting practices were conducted exclusively for religious reasons and cannot be reconceptualized as a form of an eating disorder without radically altering their original purpose and meaning.

“Varieties of psychiatric criticism” (Thomas Szasz)

I present a brief overview of the history of psychiatric criticism, followed by a critique of modern objections to diverse psychiatric practices, focusing on the critics’ neglect of the core problematic issue – the psychiatrist’s role in depriving innocent persons of liberty.

The issue also contains the classic psychiatric text “De la non-existence de la monomanie” by J.-P. Falret, commented by Thomas Lepoutre and Tom Dening, as well as book reviews of Andrew Scull’s Madness. A Very Short Introduction; Volker Roelcke, Paul Weindling and Louise Westwood (eds)’ International Relations in Psychiatry: Britain, Germany, and the United States to World War II; Katharine Hodgkin (ed.)’s Women, Madness and Sin in Early Modern England: The Autobiographical Writings of Dionys Fitzherbert; Linda V Carlisle’s Elizabeth Packard: A Noble Fight; and Angela Woods‘s The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory.

For more information, click here.

New Book Announcement – After Freud Left (ed. John Burnham)

The University of Chicago Press has just published a new edited volume entitled After Freud Left.  Edited by John Burnham, the volume includes contributions from a number of leading scholars on the development of psychoanalysis in the United States following Freud’s visit to Clark University in August and September of 1909.  The Press describes the book this way.

There has been a flood of recent scholarship on Freud’s life and on the European and world history of psychoanalysis, but historians have produced relatively little on the proliferation of psychoanalytic thinking in the United States, where Freud’s work had monumental intellectual and social impact. The essays in After Freud Left provide readers with insights and perspectives to help them understand the uniqueness of Americans’ psychoanalytic thinking, as well as the forms in which the legacy of Freud remains active in the United States in the twenty-first century.

Table of Contents


Part I. 1909 to the 1940s: Freud and the Psychoanalytic Movement Cross the Atlantic

Introduction to Part I: Transnationalizing  Chapter 1: Sonu Shamdasani, “Psychotherapy, 1909: Notes on a Vintage” Chapter 2: Richard Skues, “Clark Revisited: Reappraising Freud in America” Chapter 3: Ernst Falzeder, “‘A Fat Wad of Dirty Pieces of Paper’: Freud on America, Freud in America, Freud and America” Chapter 4: George Makari, “Mitteleuropa on the Hudson: On the Struggle Over American Psychoanalysis after the Anschluss” Chapter 5: Hale Usak-Sahin, “Another Dimension of the Émigré Experience: From Central Europe to the United States Via Turkey”

Part II. After World War II: The Fate of Freud’s Legacy in American Culture

Introduction to Part II: A Shift in Perspective  Chapter 6: Dorothy Ross, “Freud and the Vicissitudes of Modernism in America, 1940-1980” Chapter 7: Louis Menand, “Freud, Anxiety, and the Cold War” Chapter 8: Elizabeth Lunbeck, “Heinz Kohut’s Americanization of Freud” Chapter 9: Jean-Christophe Agnew, “The Walking Man and the Talking Cure”


Book Review – Richard Noll, American Madness: The Rise and Fall of Dementia Praecox (Harvard 2011)

By Jesse Ballenger

As indicated by the controversies swirling around the proposed revisions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders due to be published next year, psychiatry is probably more concerned with the categorization of diseases under its purview than any other medical specialty. Yet solid knowledge of the causes and precise pathological mechanisms that might define mental illness remains more elusive than with any other sort of human affliction. In this richly detailed book, Richard Noll explores the historical predicament of psychiatry through the efforts of America’s early twentieth century psychiatric elite to integrate their field with the main currents of an emergent scientific medicine by creating a scientific classification of mental illness.

In the second half of the nineteenth century, culminating in the emergence of germ theory and the microbiological turn, medicine as a whole increasingly oriented itself around a concept of disease specificity. Disease was no longer thought of as a general process manifesting itself uniquely in each individual, but as a specific entity with distinctive signs, symptoms, cellular pathology, and a typical course and outcome. Medicine increasingly emphasized the rational investigation of biological mechanisms or physiological abnormalities in the laboratory or on the autopsy table.

By contrast, American alienism – the term used through the early twentieth century to describe the branch of medicine devoted to disorders of the mind – seemed left behind to grapple with the protean, inscrutable and seemingly intractable nature of insanity in increasingly overcrowded, understaffed and physically decaying asylums and state hospitals. Noll argues that by adopting and adapting the European concepts of dementia praecox to the American context, leading American psychiatrists transformed their field into a branch of modern medicine.

Historians of American psychiatry, pulled toward the historiographical black hole of conflicts between partisans of Freudian psychoanalysis and the bio-pharmacological turn of the past few decades, have paid far too little attention to the influence of German psychiatrist Emil Kraepelin in the first four decades of the twentieth century. Noll’s book goes a long way toward remedying that. He devotes an excellent chapter to describing how Kraepelin revolutionized psychiatry by replacing a static view of insanity as a single entity that could express itself in a number of characteristic forms in particular patients – melancholia, mania and finally terminal dementia – with the idea that mental disorders could be sorted into distinct categories based on a rigorous, quantitative study of how clinical symptoms manifested over time. This work established two main categories – manic-depressive inanity and dementia praecox – distinguished primarily on the basis of the deteriorating course and bleak prognosis of the latter. Manic depressives improved between acute episodes, and sometimes recovered completely. Patients with dementia praecox very seldom did.

Most of the remainder of the book explores how American psychiatrists like Adolph Meyer introduced and adapted Kraepelin’s methods and concepts into American psychiatry. From a series of increasingly influential positions – first as head of pathology at the Worcester Hospital in Massachusetts, then director of the New York Pathological Institute, and finally professor of psychiatry and head of the Phipps Psychiatric Clinic at Johns Hopkins, Meyer trained nearly every psychiatrist who rose to a senior administrative position in American asylums in the first half of the twentieth century.

Meyer learned Kraepelin’s methods and nosological system during a six week visit to his clinic in Heidelberg in 1896 just as the revolutionary fifth edition of Kraepelin’s textbook was published, and returned to the United States a confirmed Kraepelinian. He was enthusiastic about Kraepelin’s methods and concepts not only because they provided a scientific basis for psychiatric research, but because they provided a rationale for asylum doctors to take a more active interest in the patients who crowded their wards. Thanks to the influence of Meyer and a few other elite psychiatrists like August Hoch and E.E. Southard, dementia praecox, which did not exist in American psychiatry in 1895, became in the space of a decade the mental disorder most widely written about in American medical journals and most frequently diagnosed in American psychiatric institutions.

Although Noll’s book mostly focuses on the thought-world of elite psychiatrists, he recognizes that most American alienists practiced in a much different world in which limitations in their training, and the lack of resources and clinical demands of the institutions they worked in, made it very difficult for them to follow the psychiatric literature published in English, let alone read Kraepelin’s original work in German. Noll argues that in their hands, Kraepelin’s classification scheme became something of a diagnostic blunt instrument – with mixed results for patients. To the good, Kraepelin’s emphasis on clinical observation restored interest in patients and their symptoms, and Noll thinks it likely that some patients benefitted simply from the increased attention. Moreover, since the major categories of mental disorder were distinguished by prognosis, giving patients a diagnosis allowed alienists to say something about the future to patients and their families, and a diagnosis of manic-depressive insanity gave grounds for some hope of recovery. To the bad, Noll argues that the rising prominence of dementia praecox facilitated continued neglect. The dire prognosis of dementia praecox, which Noll estimates to have been the diagnosis for between one quarter to one half of institutionalized patients during this period, justified non-treatment or mistreatment.

Noll shows that American psychiatrists began to stretch the concept of dementia praecox almost from the moment it entered American psychiatry in 1896. In part, this reflected the relative isolation of workaday asylum alienists described above. But even elite American psychiatrists were dissatisfied with several ambiguous aspects of Kraepelin’s concept, and by 1904 Noll finds prominent neurologists and psychiatrists complaining that the term was so malleable that it could be applied to any young person with a serious mental disturbance. The imprecision with which psychiatrists used the term dementia praecox became an embarrassment to the profession when it was mocked in the sensational murder trial of Henry Kendall Thaw in 1907. As widely reported in newspapers around the world, numerous prominent alienists testified as expert witnesses for both sides in the trial and offered conflicting diagnoses, and the strange new term dementia praecox that many had used was lampooned in the closing statement of the defense attorney as “dementia Americana.”

In addition to the slipperiness of diagnosing dementia praecox, many leading psychiatrists, including Meyer, were frustrated that it implied nothing about the cause of mental illness. Kraepelin had rejected the “brain psychiatry” that developed in Germany in the 1860s and ‘70s because he thought its focus on finding the cause of mental illness in specific brain pathology was reductionist and premature. He thought that the first priority of a scientific psychiatry had to be using rigorous clinical observation to establish disease concepts that corresponded to natural disease entities. Kraepelin assumed that dementia praecox had a biological basis, probably in systemic autointoxication, but thought psychiatry should resist etiological speculation in favor of classification based on clinical observation.

Leading American psychiatrists could not easily abide such restraint. In the first two decades of the twentieth century, dozens of articles appeared in the psychiatric literature trying to establish a specific neuropathology for dementia praecox, or compiling laboratory data of various bodily functions of praecox patients to try and identify evidence of autointoxication or “endocrinopathy.”  Despite initial enthusiasm, none of these studies shed much light on the causes of madness, but Noll argues they did serve to demonstrate that psychiatry shared the sort of methods and concerns that characterized modern medicine as a whole. They also encouraged some unfortunate adventures in therapeutics. Convinced that the cause of dementia praecox was autointoxication, Bayard Taylor Holmes, a Chicago surgeon whose son was stricken with the disorder, developed a surgical treatment that involved removing part of the appendix and maintaining an open appendicostomy to allow for frequent direct irrigation of the bowel to remove the infectious material that he believed was the cause of mental derangement. Holmes’s first patient – his son – died of complications following the treatment, but he claimed modest success in the more than twenty patients he and his associates operated on. Others, most notably Henry Cotton at the Trenton State Hospital, developed similar surgical treatments that generated initial excitement, but ultimately failed to produce meaningful results. Hundreds of patients suffered the painful and often fatal consequences of the therapeutic optimism fostered by biological theories of dementia praecox.

Meanwhile, many other American psychiatrists, led by Meyer, grew scornful of narrow laboratory approaches to psychiatry and began to approach dementia praecox as a psychodynamic disorder whose origins could be found in a pre-morbid personality type marked by psychosocial introversion, disorganized habits, and maladaptive psychological reactions to the biological, social and emotional challenges of life. The search for psychogenic causes of dementia praecox led Meyer and his followers to pay increasing attention to the peculiarities of individual patients, thus moving them away from mainstream medicine’s concept of diseases as discrete entities that could be isolated from the particularities of individual patients. By the late 1920s, most psychiatrists intent on finding the psychogenic roots of insanity began to use the term schizophrenia rather than dementia praecox. Noll argues that this represents more than a simple change in nomenclature, as is often suggested, but a fundamentally different approach to psychiatry that emphasized psychological reactions as holding both the key to diagnosis and a potential means of treatment. The concept of schizophrenia proved especially attractive to more doctrinaire followers of Freudian psychoanalysis who became the dominant force in American psychiatry in the 1940s.

In an epilogue, Noll makes explicit the critique of eclecticism in American psychiatry implicit throughout the book. During the period in question, psychiatric elites like Adolf Meyer embraced ambiguity, making room under Meyer’s capacious notion of “psychobiology” for conflicting theories and practices, ranging from psychosurgery to psychoanalysis. Noll acknowledges that Meyer’s eclecticism was in part at least a “pragmatic response to clinical perplexities” that “imposed a fragile peace on rivals in the service of “the greater goal of restoring maladjusted individuals to society” (276). Though Meyer and even more the early psychoanalysts were committed to a psychogenic approach, they understood that biological research and somatic treatments were essential for the prestige of the profession.

But Noll argues that this eclecticism kept alive a tendency to emphasize the peculiar expression of disease in each individual rather than identifying the general characteristics that other branches of medicine used to demarcate specific disease entities, and ultimately marginalized laboratory research and statistical methods, and inhibited psychiatry’s integration into the increasingly powerful and prestigious modern medicine. The enforcement of doctrinaire psychoanalysis in the 1940s and ‘50s was an attempt to solve the problem by constructing a rigorous theory of psychogenic disease that could rival the explanatory and therapeutic power of biomedicine. But psychoanalysis was plagued by ambiguity and paradox and ultimately failed. From the 1960s on, progress in biomedical research into brain chemistry, psychopharmacology and genetics provided the basis for the rationalization of psychiatry that culminated in the triumphant return of Kraepelinian psychiatry as embodied in the DSM-III of 1980.

Many historians will take issue with some or all of Noll’s critique. I tend to take the clinical perplexities psychiatry has always faced more seriously than Noll, and find grounds for skepticism whenever psychiatric theories of any stripe have arrogantly asserted that the fundamental ambiguity of mental disorder has finally been vanquished by science. But the great strength of this book is that it invites intellectual engagement. Noll does not allow his own interpretive commitments to overwhelm the narrative; his representation of the world of American psychiatry during this critical period is so rich and nuanced that readers are able to develop alternative interpretations even as they consider his. In other words, it generates much more light than heat and should be widely read by historians, neuroscientists, clinicians, social scientists and educated general readers interested in understanding medicine’s efforts to come to terms with mental illness. Given the issues at play in the upcoming revision of the DSM, a work of mature, responsible historical scholarship is a timely and valuable contribution to the broad discussion we need to be having about what is at stake in psychiatric classification.


Jesse Ballenger is an associate professor in the Science, Technology, and Society program at Penn State University. He is the author of, among other works, Self, Senility and Alzheimer’s Disease in Modern America: A History (Johns Hopkins University Press 2006).


Is Bereavement Counseling the Victim of a Statistic With a Life of its Own?

Image of Woman Whose Face Expresses Sadness (from:

Christian Jarrett over at the British Psychological Society’s Research Digest has posted an interesting piece citing a 2007 article by Larson and Hoyt entitled “What has Become of Grief Counselling? An Evaluation of the Empirical Foundations of the New Pessimism.”  As Jarrett points out, “It has become the received wisdom in psychological circles that bereavement counselling is at best ineffective and at worst harmful, especially when offered to people experiencing ‘normal’ grief.”  Bereavement counseling’s poor reputation, Larson and Hoyt note, is largely attributable to a 1999 dissertation by Barry Fortner which concludes that some 38 percent of grieving clients would have done better had they received no treatment at all.  The problem, according to Larson and Hoyt, is that the 1999 dissertation has itself only been cited once, by the author’s colleague Robert Neimeyer.  All other references to the 38 percent figure cite only Neimeyer.  Having submitted the dissertation to a post hoc peer review, Larson and Hoyt find, “The experts conclusively agreed that [Fortner’s methodology] is seriously flawed and that there is no valid basis for the claim that 38 per cent of grief counselling clients suffered deterioration.”

Historians of psychiatry and psychotherapy may well find the comments on Jarrett’s post equally interesting.

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