How I Became a Historian of Psychiatry: George Makari

We are delighted to present an interview with George Makari, M.D., as part of our “How I Became a Historian of Psychiatry” series. Dr. Makari is a historian, psychiatrist and psychoanalyst, serves as Director of The DeWitt Wallace Institute of Psychiatry and the Oskar Diethelm Library at Weill Cornell Medical College, where he is also a Professor, and is the author of Revolution in Mind: The Creation of Psychoanalysis (NY: Harper Collins, 2008). He has kindly agreed to share with us his intellectual trajectory.  

How did your interest in the history of psychiatry develop?

I would say fortuitously. The origins of something like that, for me at least, started out in a much more general kind of interest. I came from a family of doctors and it was always assumed that I would become a doctor too; I actually got into medical school out of high school, so there was a road paved in front of me. However, when I was doing my undergraduate studies I became very interested in history, literary studies and writing. Part of the challenge then was to integrate these two interests. After my undergraduate education, I spent a year as a newspaper book reviewer and did some volunteer work in a child psychiatry department. I was trying to discover how I might  combine these things that I felt very committed to, which were writing and helping others, trying to be someone who had that kind of direct impact on people. It was also a time when Foucault was extremely influential, and Janet Malcolm wrote In the Freud Archives. It became increasingly exciting for me to imagine that I could integrate my interests by writing and being a psychiatrist. That writing eventually took the form of history.

The second thing I should mention was the importance of my intellectual community. You can have all these ideas about what you might be or do, but it’s very important to have a community that in some ways supports those inklings and helps them develop. As a medical student, I came to Payne Whitney (Cornell), where there was this extraordinary division that studied the history of psychiatry and was interdisciplinary – there were a lot of doctors and there were a lot of historians and these people were doing very exciting work. So that made it all seem very natural that I could do those things too.

At which point did you think, “I’m going to write a book”?

Well, that I’m afraid is a long story too! I started a project that was much narrower and much more defined, which was a history of transference theory and its relationship to German philosophy and medicine. I saw the potential for something really interesting about how this theory came from interesting currents in European philosophy and culture. And the pre-existing literature claimed the theory was de novo, came from Freud’s originality alone. So I took that project one step at a time and first researched the earliest use of transference as a notion in Freud. And then I moved on to the next one: I wrote a series of papers. Eventually, I thought, at the end of the day I’ll string all these papers together and I’ll have a monograph on the history of transference theory.

But a funny thing happened on the way. I had gotten a grant from the International Psychoanalytical Association and that really helped me do a lot more archival work in Europe. I ended up coming home with tons of new information from archives —all sorts of things that seemed important. So I tried stick these newer discoveries into that smaller project. I stuffed all of this good material into a book proposal that I prepared on transference. If anyone reading this interview is in the process of writing a book proposal, I suggest that you get the smartest person you can find to rake you over the coals before you write the book. That’s what I did, and again this has to do with having a generative community here at the Institute.

This discussion about my book proposal went badly, and it ended up being about how there were really two books in my proposal: one about transference and another about much broader issues in the history of the field. Feeling defensive, I argued that if someone else had written a book on the origins and development of psychoanalysis as a field in Europe, I wouldn’t have to put all that stuff in there, I could just refer to that work. But, I blurted out, in fact no one had written such a book. When I said that—when I heard myself say that—I was a bit taken aback. It seemed like that couldn’t possibly be true. But the more I thought about it, I was dismayed to recognize that it was true. No serious book had been written about the creation, consolidation, crisis and reworking of psychoanalysis before the collapse of Europe. And at that moment—actually it wasn’t a moment, it was a couple of very uncomfortable weeks, I transformed the book I had long planned into the one I now would write.

It was an organic process that involved knowing exactly where one wants to go, getting lost in archives and research, and then rediscovering a way that is more dictated by the materials and the opportunities they offered.

Once the book came out, did you find that its reception differed amongst the two communities (physicians and historians)?

They definitely have different approaches to it. I’m a bit spoiled because the reception has been extremely positive on both sides. But different people were interested in different aspects of the book. I think historians of medicine and historians of modern European culture responded to the way that intellectual history was integrated into social and political history; to the way I employed notions of discursive communities to link those two things and not have theories and concepts kind of floating out in space. Since much of historical discipline tends toward social history, they appreciated that integration.

I think the physicians, the psychiatrists, and especially the psychoanalysts who care so deeply about their history, appreciated how rich this restored tapestry was; in a way, they knew a very threadbare version of their own past. And I think they responded to the book in relationship to the contemporary struggles within psychoanalysis. Some at least felt that this account held important lessons about how truth claims are made, how they’re verified, how they’re not verified in psychoanalysis; they saw this – as opposed to standard great man biographies – as an attempt to understand the psychoanalytic community—what led to schisms, what’s led to the orthodoxy, the kinds of struggles and turbulence that community has had and still has.

On your side, how has this awareness of the history of psychiatry influenced the way in which you treat patients, and vice versa, how does being a psychiatrist affect the way in which you practice history?

It’s complicated because on the one hand, the obvious answer would be that studying history relativizes your view of any particular truth claim from the present. And that’s in fact partially so.  Historical mindedness does make me think differently about diagnostic categories, about claims for different novel advances. Right now, for example, it makes you turn a cold eye toward a lot of the claims that are coming from neuroscience and the psychopharmaceutical industry. It allows you to at times adopt an Olympian view, which can be very helpful. But the problem with that is that patients are coming to me for help. So I have to be committed to something; I have to be engaged in a way that will be helpful. You can’t sit there and philosophize about what this category error means about our culture. So in a way it forces you to take a stand, even in a situation where you have only a limited level of certainty, about how to benefit and console patients of different sorts. In that sense I think it’s been a really interesting process, but not an obvious one at all.

In terms of how being a psychiatrist affects my being an historian, that’s a touchy question, because what I’m very much not is a psycho-historian. Given the excesses of psychoanalyzing the history of psychoanalysis, I took great pains to not speculate about the inner states and inner motivations of the players in the book [Revolution in Mind]. At the same time, I would be a liar if I didn’t say that my experience studying character and human behaviour aren’t all over that book. When anyone tries to deeply understand a historical character, reading letters or diaries, going through their choices, you need to somehow pull together a sense of who they were. For example, sometimes there’ll be these telling moments, ones that literature uses to great affect. Flaubert was a genius at this. I think about those kinds of things every day, for seven or eight hours a day. So I am sure that process does not stop when I think about historical characters and how they negotiate their internal and external worlds.

Many thanks to Dr. Makari for this fascinating interview!

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