Book review – Thomas Müller (Hrsg.), Zentrum und Peripherie in der Geschichte der Psychiatrie. Regionale, nationale und internationale Perspektiven (Steiner-Verlag, 2017)

Eva Andersen, Université du Luxembourg

In recent years spatial and transnational history have slowly begun to make their marks on historical research. Yet aside from numerous theoretical discussions about the meaning of transnational history, literature with practical case studies, especially in the area of medical and psychiatric history, remain rare. Thus, every new book that promises a practical approach is immediately of interest to historians framing their research within these spatial/transnational perspectives. Therefore, the title of the book under review immediately captured my attention. As with previous publications in the spatial/transnational domain, such as the notable work International Relations in Psychiatry[1] as well as Transnational Psychiatries[2], the goal is to enrich the history of psychiatry by researching what happened in and between different — local, regional, national and international — settings. The book Zentrum und Peripherie forms another addition to this growing corpus of literature. The editor (Thomas Müller) and the authors contributing to the volume criticise research that has only been directed towards the centres of psychiatry — be it in the form of an institution, changing treatments or psychiatrists associated with them (p7-8) — setting themselves the goal to break this restricted framework and focus on the changing meaning of centre and periphery. The volume therefore analyses the history of psychiatry in the nineteenth and twentieth century on a regional, national and international level. This approach breaks with the tradition of studying the impact of local, national and international histories in standalone articles or books, solely dealing with one of these frameworks. To analyse these different settings the volume is divided into four sections dealing with (1) regional psychiatry in southwest Germany, (2) regional psychiatry in north Germany, (3) psychiatry beyond the nation and Europe, and last (4) the history of psychiatry from a public history point of view. Within these sections each article (in German or English) explores the meaning(s) of centre and periphery.

The first two sections mostly deal with the geographical tension that psychiatric institutions and sanatoriums created between the urban (centre) and the rural area (periphery), showing the different local or national outcomes this had on psychiatry. The contextualisation of the articles provides the reader who is not that familiar with the history of (local) German psychiatry with sufficient background information. For example, Grauer’s article focused on the diagnostic practices of the private irrenpflegeanstalt in Wurttemberg, headed by Johannes Irion and Heinrich Koch during the nineteenth century, in a geographical region that has not been investigated on a regular basis. As mentioned earlier the urban-rural theme plays a prominent role in many of the articles and unmistakably demonstrates that the concepts of urban/rural and centre/periphery are ambiguous. These concepts should not be viewed as rigid categories but rather as superfluous classifications that, as Prüll noted, often constitute a grey zone. Therefore, the publication problematizes and supports these statements with stories about the shifting importance of the University hospital in Freiburg and the Landeskrankenhaus Emmendingen through the nineteenth and twentieth century. Prüll demonstrates that both institutions lost and took back their central role: the University for example gained a dominant position during the First World War as it made efforts to treat shell-shock and similar afflictions. However, during the Nazi era it would be the Landasylen that would play a central role in the T-4 action. By researching the (non)existence of actual and perceived connections between the city of Hamburg and the Irrenanstalt Langenhorn located in a more rural region, Ankele breaks with the idea that psychiatric institutions were peripheral worlds upon themselves. Instead the author discusses the positive and negative consequences of transportation lines (walking, coaches, trains, automobiles) that were established between the city and the asylum, changing the original centre/periphery and creating another dynamic between the psychiatric institution and its environment. Sebastian Kesseler on the other hand describes how socio-economic crises in urban-rural areas had an effect on the diagnoses of mental illness in the Günzburg psychiatric hospital. To support this claim, he uses quantitative as well as qualitative data based on the analyses of four medical records of male patients during the great depression.

Zooming out, the book incorporates articles that deal with a more local-national level, where different authors write about the impact of war on psychiatric institutions. Uta Kanis-Seyfried explores the Württemberg institution newspaper Schallwellen during the period 1897-1936, noting that micro-histories can also say something about the macro-scale (p43). Based on the content published by the nationalistic Albert Uhl concerning the war in general and the staff that was sent off to fight, she describes the impact of the First World War on the journal and the asylum. Although the article did not focus enough on psychiatry itself, it still demonstrates how this journal crossed boundaries ‘between academics and the less educated, between healthy and sick, between village and institution, between home and far away’ (p62-63). The article by Fangerau illustrates that we have to be careful in overgeneralising ‘nationwide’ practices or influences in psychiatric history — in this case the prescribed treatments for neurasthenia. By contrasting the treatment of shell-shock in the Rasemühle sanatorium to the practices at the battlefront hospitals during World War I he demonstrates that the peripheral position of the sanatorium (located further away from the front) was fundamental in allowing treatments that did not exist in hospitals located near or at the battlefront (centre). Consequently, ‘generalised’ treatments such as (harsh) verbal suggestions and electric shock treatments were not used in the sanatorium where shell-shock patients were treated with pre-war methods (i.e. pine needle baths, massage, rest, and occupational therapy).

A noteworthy article in these two first sections — and a leap to the next section — written by Wulf takes a completely different approach to the centre and periphery by looking at the interplay between the German colonies and Germany in the beginning of the twentieth century. More specifically he explores the mentally ill ‘Africa-returnees’ from the German Schutzgebieten who were admitted to the Irrenanstalt Friedrichsberg in Hamburg. He takes into account the perception, interaction and negotiation process when it comes to diagnosing madness, which is rarely considered in current literature. Moreover, he thoroughly explores this negotiation process from three different stages, namely in the colonies, in Germany and aboard the ship that carried the patients from the former to the latter.

In the third section the theme of ‘interplay’ is explored even further by analysing the exchange between Western and Eastern psychiatry via examples from India and Japan. The authors in this section highlight the importance of interaction and the ‘in-betweenness’ of knowledge production and circulation. In her article Ernst stresses that — real as well as imagined — centres and peripheries constantly shift and that “what we consider the ‘centre’ depends on our vantage point and on the provenance of the particular map we are looking at” (p155). She locates psychiatry in British India in this constantly changing centre-periphery-model during the early twentieth century by studying the Indian doctor J.E. Dhunjibhoy. This is a refreshing departure from the focus on psychiatric institutions in previous articles. By taking a close look at this Indian psychiatrist she illustrates how “[h]is diagnostic mindset was flexibly cosmopolitan and transnational and cannot adequately be captured by reference to any single approach, let alone be restricted to ‘colonial psychiatry’” (p166). Dhunjibhoy negotiated constantly between different centres and peripheries on a socio-political as well as medical level. She convincingly argues that referential frameworks in psychiatry were constantly transcended across the globe, which should be researched more often. The last two articles, written by Hashimoto & Suzuki both deal with Japanese psychiatry, and are of the same allure as those of Ernst & Wolf. Hashimoto uses the concepts of centre and periphery to explore how Japanese doctors incorporated and revised the knowledge they acquired in Germany, Austria and the USA. In his article he illustrates how knowledge gathered by Japanese doctors did not merely constitute the import and reproduction of knowledge, with the exception of the generation of Japanese psychiatrists trained abroad. Japanese doctors also looked for originality and made their own contributions in Japan based on what they had learned. Suzuki’s article is concerned with eugenics in Japan during 1935-1945 and elaborates on the different practical outcomes the eugenic rhetoric had in Germany and Japan, in spite of the German influence that Japan experienced. The psychiatric surveys that were held in peripheral locations in Japan where not used to capture and confine mentally ill people or to confine them to a hospital, rather they were confined to their family and the community where they lived (p198).

The last section includes two articles on the importance of communicating research on the history of medicine/psychiatry to the general public through cooperations with museums, archives and the public itself. Müller and Celia Di Pauli and her colleagues believe travelling exhibitions form a valuable way of disseminating research to the public. At the same time, these exhibitions allow the public to interact with what we perceive as the centre and periphery. The article of Celia Di Pauli et al contains a detailed account of the format of such an exhibition and they conveyed their message to the public. Although the theme of centre/periphery and local/international are present in both texts, I missed some connection to the other sections and articles in this volume because this last part mostly focuses on the dissemination of historical research to the broader public.

In general, many of the chapters offer interesting insights into the fluid boundaries of what constitutes centre/periphery and local/international, including their interchangeability. What striked me most was the convincing argument that regional/national histories still have their value. As a historian mostly focused on transnational histories, I sometimes tend to forget that transnational histories are not the ‘holy grail’. The articles in the first two sections demonstrated that on a regional/national level there is still much to uncover about the different practices and developments that took place and that local histories can also influence history on a macro-scale. I loved that the book takes into account local, national and international perspectives, although they maybe could have integrated more interactions between the different sections in the book. The editor and authors of the volume also left out the interaction between centre and periphery in Europe itself. Apart from this peculiar omission the book is an interesting read showing the multitude of histories that can be written from local to international points of view.

[1] Volker Roelcke, Paul J. Weindling, and Louise Westwood, eds, International Relations in Psychiatry: Britain, Germany, and the United States to World War II, Rochester, 2010.

[2] Waltraud Ernst and Thomas Mueller, Transnational psychiatries: social and cultural histories of psychiatry in comparative perspective c. 1800-2000, Newcastle upon Tyne, 2010.


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