Review – Stephanie Coché, Psychiatrie und Gesellschaft. Psychiatrische Einweisungspraxis im „Dritten Reich“, in der DDR und der Bundesrepublik 1941-1963, (Göttingen 2016)

Max Gawlich, University of Heidelberg

I was assigned this review at the very end of my own writing process, having just finished the proof corrections and sent the manuscript off to the printer. So to review the work of Stefanie Coché is an occasion to reflect on my own writing as well as on trends in the historiography of psychiatry in a more general sense. Reviewing a study like “Psychiatrie und Gesellschaft” by Stefanie Coché constitutes an ambivalent task. Since other reviewers ([1][2]) as well as prize committees, e.g. the German Society for the History of Neurology, have already established that her work is worth reading, it is very unlikely to come to a completely new assessment and it appears almost superfluous to describe her work and research yet another time. However, this situation also offers an opportunity to engage more freely and deeply with her study. In this review I will focus on two major points. First I take a closer look on her emphasis and problematization of family in the context of admission to psychiatric Hospitals. The second point focusses on some problems regarding research mainly seen as theoretical in contrast to empirical studies. On this occasion she highlights some issues which have repeatedly been problematized in the discipline, e.g. patient files as source material, the perspective of patients as well as the relations of structures, organisations and individual actors. Furthermore, the function of theory, the dominant focus on the 18th and 19th century in the history of psychiatry and the reception of Michel Foucault.

Coché has written a social history of the processes, practices and relations that result in the hospitalization of individuals. Regarding her main topic of psychiatry and society she sets out four main foci, which also structure her study. In the first she studies the structures and actors involved in practices of admission. The second main point then is forced admission in the context of endangerment, policing and state as well as the family. In a third part the author focusses on the medical aspects of admission, paying particular attention to continuities and ruptures in self-descriptions of psychiatrists, nosological knowledge and diagnostic practice. The fourth point is the relation between admission to an asylum and labour or the ability to work. The structure of her study notably reflects the process of research and also develops the main argument resulting in a strong connection of family, labour and psychiatry. Coché shows how administrations, psychiatrists, patients and before all others families engage with each other in practices of admission. Family members are able to utilize psychiatric knowledge, administrative regulations and relations to communal physicians in admissions to psychiatric hospitals. Coché emphasizes in accordance with Jens Gründler [3], that families are able to use psychiatric hospitals and admissions to them as social resources. (296-7) Remarkably, they used them notwithstanding of political and societal ruptures, war, or social background. Her overall findings and the emphasis on the role of family are convincingly developed and mark a continuity in the role played by the modern family. The central position families obtain over the identification and management of madness, was first described by Michel Foucault for the late 18th Century.

“For this brief moment, it [the family] openly was what it was long to remain in more covert form – the most immediate instance of division between reason and madness, an archaic and simple form of justice that likened the rules of life, economics and family obligation to the norms of good health, reason and freedom.” [4]

These findings raise further questions regarding the institution of family. How does this small social unit change under the pressures of radicalized National Socialist rule, war and post-war society, or how was it affected by the structural social innovations in the new German states, and what effects did those changes have on processes of admission? The crisis or the demise of the Family were common sociological diagnoses in post-war Germany just as were descriptions of the family as last lifeline in the so called rubble-society. The dynamics and relations Coché identifies in the negotiations over the admission to a psychiatric hospital could also be studied from the opposite perspective. So family and its members would not only appear as social actors in historical relations but as historical products of social relations as well. From this perspective, to admit a family member to a psychiatric hospital is a social practice, that has effects on the family too. A further result of her study is therefore the need of supplementary research connected to the history of family and socialisation, an issue often raised by contemporary psychiatrists as well.

With respect to my second focus, Coché’s work is an example of recent trends, in particular in studies self-described as praxeological, to place less emphasis on theoretical discussions and take an explicit stand for empirical research. She attempts to use patient files as source material for patient’s histories and puts her approach in contrast to a focus on medial and formal qualities of files, a focus she identifies in the history of medicine in Germany of recent years. (35-6) The reviewer appreciates if against apparent methodological constrictions different approaches to source material are developed. Coché sets out how a hermeneutic reading, focussing on the content rather than the form or structure of patient files, still holds important insights. For the history of psychiatry, this just offers a greater variety of accounts. An empirical approach still has to be epistemologically reflected upon, otherwise it transforms into empiricism, disregarding theoretical arguments and available insights. In recent research, this appears to be true in particular in relation to the work of Michel Foucault and historical scholarship referring to him. Hereby apparently a specific ghost of Foucault haunts recent scholarship, which sets out to liberate itself and historiography from him.

However, this version of Foucault rests on a misconception; regarding his research, problematic abbreviations and exclusions are reproduced and essential insights misrepresented. Sufferers admitted to the asylum e.g., who speak as ‘patients’ about their ‘illness’ in psychiatric terminology, are not evidence against the differentiation of reason and un-reason in the age of Enlightenment that Foucault developed in his thesis. (106-7) The following quotation from the History of Madness shows, that it is exactly the place of the asylum, where madness and medicine can freely speak.

“But on the one hand, with medicine, we find the work of a form of knowledge that treats the different forms of madness as so many natural species; on the other, an attempt at recognition that lets madness ‘speak’ for itself, allowing voices to be heard, which for the first time in the history of the Christian West are neither those of prophecy, nor trance or possession, nor buffoonery; voices where madness speaks for nothing or no one else, but for itself. In the silence of confinement, madness had strangely conquered a language that was its own.” [5]

The history of psychiatry in the 20th century already established some new narratives against the backdrop of the 18th and 19th century. The dissemination of a wide array of therapeutic actions, the further propagation and growth of institutional care until the 1960s and the following de-institutionalisation require new stories in the history of psychiatry. Stefanie Coché tries to explore new actors and uncommon periods, as she studies the participants in practices of admission. Still her conventional focus on admission, on the so called threshold between psychiatric hospital and society, reproduces well established dichotomous relations between those two systems. This is a binary order that the reviewer himself relies on in his historiography. Whereas social histories of psychiatry often focus on structures, legal and health regulations of psychiatry from the perspective of society, the contrasting image is developed by institutional, medical and everyday histories studying the life intra muros. A study focusing on the structures, actors and practices in processes of admission only apparently undermines this dichotomy. As Coché actually herself highlights, the process of admission is a crucial point in the construction of the borders and walls between asylum and society. (296) At least to this reviewer it remains doubtful, whether this is the history to narrate. The task to integrate psychiatry as part of society in a social history still waits for its historian. It might be possible to take Foucault’s and others’ insights as a point of departure, examining e.g. how their research and their theoretical insights have been shaped by historical change in the second half of the 20th Century – exactly these processes of historical change the historiography of psychiatry is struggling to grasp.

 

[1] Pfütsch, Pierre (2017): Rev.: Psychiatrie und Gesellschaft. Psychiatrische Einweisungspraxis im »Dritten Reich«, in der DDR und der Bundesrepublik 1941–1963. In: H-Soz-u-Kult. URL: <http://www.hsozkult.de/publicationreview/id/rezbuecher-27437&gt;.

[2] Engstrom, Eric J. (2017): Rev.: Stefanie Coché, Psychiatrie und Gesellschaft. Psychiatrische Einweisungspraxis im ‘Dritten Reich’, in der DDR und der Bundesrepublik 1941–1963. In: Med Hist 61 (04), S. 592–594. DOI: 10.1017/mdh.2017.61.

[3] Care and Control: How Families Used Asylums, Glasgow 1875–1920, in: Andreas Gestrich /Elisabeth Grüner/Susanne Hahn (Hrsg.): Poverty in Modern Europe: Spaces, Localities, Institutions

[4] Foucault, Michel (2006): History of madness, ed. by Jean Khalfa and Jonathan Murphy, London: Routledge, p. 447.

[5] Ibid. p. 393.

___________________________

Max Gawlich teaches at the University of Heidelberg. He is the author of Eine Maschine die Wirkt. Die Elektrokrampftherapie und ihr Apparat, 1938–1950 (Ferdinand Schöningh 2017).

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