Author Archive

Workshop announcement: Brainwashing, Film, and the Psy Sciences

The Hidden Persuaders Project and the Birkbeck Institute for the Moving Image cordially invite you to:

Brainwash: History, Cinema and the Psy Professions

3rd and 4th of July 2015, 10:00am-6:00pm

Birkbeck Cinema
43 Gordon Square
WC1H 0PD London

The history of cinema, like the history of psychoanalysis, psychiatry and psychotherapy, percolates with Western suspicions that our minds are susceptible to covert, even unconscious manipulation. Cinema and psychoanalysis—two essential exponents of subjectivity in the twentieth century—have been celebrated as royal roads to the unconscious, catalysts for our dreams, and means of self-discovery and human emancipation. But cinema and psychotherapy, Freudian or otherwise, have also been castigated for their special capacity to tap the unconscious, and as tools for mind control, even as they have depicted and shaped understanding of what it means to have or to manipulate a mind.

In this workshop we ask whether the Cold War obsession with brainwashing was a break with past narratives and anxieties over mental manipulation and suggestion. We consider how far cinema, television and video have been caught up in this history of hidden or coercive persuasion, and how far they have changed the terms of debate. What forms of human experimentation inspired interest in brainwashing, and vice versa?  And how and why did depictions of automatism on screen so often connect to fears of the ‘psy’ professions?

In addressing these questions we revisit some iconic and obscure brainwashing sagas of the past. By re-examining Cold War films and some of their precursors, we invite discussion of the representation of coercively altered states of consciousness—the dangerous spell that film and ‘the talking cure’ have been said to exert.

Workshop Programme

3 July

Raymond Bellour (Centre National de la Recherche Scientifique): Cinema and Hypnoses: Mabuse as an example

Laura Mulvey (Birkbeck, University of London): From Momism to The Feminine Mystique
Maya Oppenheimer & Rod Dickinson (University of West England):  Re-enacting Obedience: laboratory on film

Jelena Martinovic (Geneva University of Art and Design): Depatterning desire: Aversion therapy on film
Laura Marcus (University of Oxford): Flicker

Marcie Holmes (Birkbeck, University of London): Flickering lights: mind control on screen

4 July

Ian Christie (Birkbeck, University of London): The Soviet story: From interrogation to confession

Ana Antic (Birkbeck, University of London): Cinema and education: Building the new communist person
Erik Linstrum (University of Virginia): Interrogating The Interrogator: Cyprus, the BBC, and the performance of violence

Gavin Collinson (BBC): Brainwashing on the Box: Depictions of brainwashing on British TV
Daniel Pick (Birkbeck, University of London): Suddenly: Some thoughts about assassination at the cinema

Simon Schaffer (University of Cambridge): Manchurian Automata

The full programme and free registration for this event can be found on Eventbrite.

Hidden Persuaders: Brainwashing, Culture, Clinical Knowledge and the Cold War Human Sciences

Logo_Hidden_Persuaders_Primary2

Under the direction of Daniel Pick, the Birkbeck College project ‘Hidden Persuaders: Brainwashing, Culture, Clinical Knowledge and the Cold War Human Sciences’, has launched a website with an accompanying blog:

Upcoming events and announcements include the following:

14 May seminar with Catalina Bronstein
Prof. Catalina Bronstein will lead a seminar on “Working in Fear: Memories of Psychiatry and Psychoanalysis during the Argentinian Dictatorship.” This seminar will be held from 11:45-13:30 on Thursday, 14 May, at Birkbeck. Catalina Bronstein is a Visiting Professor in the Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology within the Division of Psychology and Language Sciences (PALS) at University College, London where she is the coordinator of the MSc seminars on Melanie Klein. She is a Training Analyst and Supervisor and a Fellow of the British Psycho-Analytical Society. Prof. Bronstein originally trained in Medicine and became a Psychiatrist in Buenos Aires, Argentina. She will be speaking about her experiences as a psychiatrist during Argentina’s ‘Dirty War.’
21 May seminar with Robert Jay Lifton
Robert Jay Lifton will lead a seminar on Thursday, 21 May at Birkbeck. Prof. Lifton is a psychiatrist and well-respected author of many books, including Thought Reform and the Psychology of Totalism (1961) and The Nazi Doctors (1986). Prof. Lifton will speak on his early research on Chinese ‘thought reform’ – exploring what this can tell us about what he calls ‘totalism’ – and his study of the psychological and ethical issues surrounding the atomic attack on Hiroshima. He will reflect on his psychohistorical research methods, including the development of his interview approach, use of psychoanalytical principles, and his perspective on the psychoanalytical movement in America.
Doctoral Studentship—deadline 1 July
The project’s website has announced a doctoral studentship. Students interested in applying for this can find more information here: http://www.bbk.ac.uk/hiddenpersuaders/blog/new-doctoral-studentship-deadline-1-july/

 

Book Review – Jan Goldstein, Hysteria Complicated by Ecstasy: The Case of Nanette Leroux (Princeton University Press 2011)

Screen shot 2013-01-11 at 3.15.33 PMBy Michal Shapira

Jan Goldstein’s new book Hysteria Complicated by Ecstasy: The Case of Nanette Leroux is a compelling and intriguing demonstration of what can be gained by close study and analysis of one archival manuscript of a medical case history. The case in point tells the story of eighteen-year-old Nanette Leroux, a village girl from Savoy who fell ill in 1822 with diverse nervous symptoms (among them convulsions, lethargy, sleepwalking , and what her physicians called catalepsy, that is a muscular contraction that fixed her limbs and other body parts in their positions when the symptom took hold). Nanette’s doctors believed the girl to be suffering from “hysteria complicated by ecstasy” following repeated “frights” caused by a rural policeman said to have tried to “offend her modesty.” Goldstein discovered the lengthy (200 page) manuscript at the Institut de France in Paris, and she uses this archival find as a window into a wide-range of historical contexts and methodological questions. The book is divided into two parts which in themselves serve as an interesting model for a historical critical edition: the first half of the book is a meticulous exercise in micro-history providing context for and interpretation of the archival text, and the second half includes the translated and transcribed manuscript itself. Indeed, despite the manuscript’s obscurity, Goldstein is able to successfully “milk it for what it’s worth” and to demonstrate why it is noteworthy. Her ability to reveal and discuss early nineteenth century rural and small-town life in the Alpine region of Savoy and some of the medical debates and conceptualizations of the time is inspiring.

 

While the psychiatric case as a genre grew in length over the course of the nineteenth century, here we have a detailed, and therefore significant, archival example from early on in the century. Through the text, we learn about the patient herself. Described as a somewhat passive, simple village girl, she also had also her moments of wit, creative use of self-expression to assert some control over her situation, and even rebellion against medical practice. We also learn about her two French physicians, Alexandre Bertrand and Charles-Humbert-Antoine Despine, and their conflicting views as they produced the medical edition. The two men came from different backgrounds. Despine was a materially comfortable man of the provinces working for the medical administration of the state-run thermal baths at Aix-les-Bains.  Bertrand, on the other hand, was a young and struggling Parisian but a scientist of the big city. What brought these two physicians together was their mutual interest in animal magnetism and Despine’s search for a worldly colleague to help him in the writing of the case. Their relationship allows Goldstein to explore the production of science in the provinces and ties with metropolitan expertise. Despine first meets Nanette after she had already been examined by a local physician and was also helped by a supportive layman. Despine’s advice was that she should be bought to Aix-les-Bains for therapies such as baths, showers, and electro-magnetism. He approached her both as a doctor trying to cure her and as a scientist aiming to experiment with the case in order to produce scientific knowledge.

 

True to her goal of getting as much as possible out of the text, Goldstein uses this micro-history to artfully explore larger macro-historical trends. Indeed her thorough approach leads her to wonder when the historian needs to stop contextualizing or when is ever “enough context.” Her method is an exhaustive one. Like a true detective, she restores the different backgrounds to the manuscript, from the immediate textual contexts of the scientific debates at the time to the larger social, cultural, political, and economic circumstances in which Nanette, her doctors, and others mentioned throughout the case lived. The result is dazzling, demonstrating how with imaginative scholarly work a broader picture can be pieced together. For example, Goldstein offers fascinating facts about the Savoy region itself under the Old Regime, the Revolution and the Piedmontese restoration. She also reveals the spa at Aix-les-Bains as an interesting and unique setting where urbane, cosmopolitan, tourist crowds meet the provincial misfortunate in a new age of travel and consumerism.

 

The context Goldstein provides is so rich that at times it seems that she drifts too far away from the medical case itself. Yet, again and again she is able to demonstrate how seeing the whole setting is important to understanding the particular episode. For instance, she shows how the tension between the traditional ways of Nanette’s native life and the burgeoning modernity and consumer market culture that the girl experienced in the spa town in fact played out in her illness. Without studying the rich background of place and time, Goldstein argues, the case’s details would have remained unclear. For historians of science and medicine, the scientific debates of the time and the different diagnostic labels of catalepsy, hysteria, and ecstasy assigned to the case are of special interest. Goldstein points out that the concept of hysteria emerged in the 1820 but that at the time it was not necessarily a uterine malady and could still be considered gender-neutral and devoid of erotic connotations. She also reveals the complex and conflicting gender dynamics at the time both between Nannette and her caretakers and impressively also inside Despine’s household.

 

But beyond contextualizing the manuscript, Goldstein is also interested in analyzing and making sense of the case. It is here that the more theoretical and methodological questions of the book emerge. A key issue is trying to answer how contemporaries conceptualized Nanette’s illness. While for post-Freudian twenty-first century readers of the text it might seem as if Nanette is suffering from sexual trauma due to the assault of the policeman, Goldstein emphasizes how the concept of psychological trauma was not yet available to contemporaries, as it would only develop from the 1870s onwards. What the participants in the manuscript did believe was that Nanette’s experience of fright served as a trigger to her illness. This early nineteenth century belief, Goldstein insists, was manifested in a manner that was utterly different than in the fin de siècle. Nanette’s doctors, for example, were not interested in a more all-embracing psychological explanation of her illness as key to self-understanding, or in memory-recovery of the violent episodes. They only aimed to eradicate her symptoms and restore her health and to find out whether animal magnetism could accomplish such goals. While the two doctors shared interest in magnetism, they favored different explanations for it. Despine subscribed to the late 18th century tradition of Mesmer, believing that the cure is of a physicalist nature, while Bertrand preferred a mentalist view of magnetism, and at times was willing to look at the illness from a psychological point of view, seeing it as stemming from Nanette’s “ideas” or “imagination.”

 

Goldstein takes her work a step further when she proposes a twenty-first-century interpretation of the case, using both Michel Foucault and Sigmund Freud to reread it in a more theoretical fashion. She defends this approach in an appendix that one wishes was more developed, especially given the theoretical tensions between these two writers. Her rationale for advancing in such a direction is that Nanette’s physicians shared certain limitations in understanding her illness that Goldstein believes invite the historian to try to improve on their work. In trying to explain why the two doctors ignored the sexual elements in the case—so obvious to a twentieth-first century reader— Goldstein uses Foucault to claim that Despine and Bertrand lived in a transitional moment in the early nineteenth century, just on the threshold of “sexuality” as it was later understood. For them, sexuality was not yet turned into an object of scientific knowledge

and was not yet part of a causal scientific explanation of a wide array of human behaviors. Despine and Bertrand functioned in the era “before sexuality” as they did not automatically connect their patient’s pathology to sex and did not locate sex at the center of her being and of her illness. Their sensitivity to sexual matters was different than ours and their concept of hysteria therefore was not so closely tied to sexuality. Hence they saw no point in analyzing in depth what seemed to be attempted rape.

 

Goldstein then uses a Freudian approach to try to conceptualize Nanette’s own subjective understanding of her situation and the causes of her illness. In a sense here Goldstein brings the case “back to sexuality” – a reverse move from the Foucauldian reading she utilizes thus far and one that could have been elaborated upon further. Goldstein is guided by the psychoanalytic assumption that Nanette possessed an unconscious mind that enabled her to manipulate cultural symbols and discursive possibilities available to her for her own means. In this manner, for Goldstein, the fact that Nannette demanded a watch of her own “surely speaks of her wish—probably unconscious and hence articulated symbolically through the medium of symptom—for some freedom from society’s relentless demands on her biological performance [as a woman], some measure of self-regulation.” (p. 118) Such a hypothesis may not appeal to all historians and may raise the question of whether it is the role of the historian to explain the described illness by twentieth-first century standards. Yet such creative reading does enable a certain interesting interpretation of the case, according to which Nanette’s illness was an expression of an unconscious psychic conflict that centered on questions of rebellion, autonomy, and traditional patterns of behaviors and dependence for a woman in her era. Goldstein argues that Nannette’s taking refuge in illness had to do with the historical change of the post-revolutionary era that exposed her to alternative, and more egalitarian, visions of the future. Located between traditional and modern lifestyles, Nannette literally embodied the contradictions of her historical moment. As this elegantly written book combines an erudite survey of multiple historical contexts, a micro-history of early nineteenth-century French and Savoyard medicine, gender and politics, and an imaginative conceptualization of a medical case, it should be of interest to any serious historian.

 

Michal Shapira is a Thomas Arthur Arnold Research Fellow at the Department of History, Tel Aviv University. She is a modern European historian focusing on the impact of total war and the development of expert culture in the twentieth century. She is the author of the book The War Inside: Child Psychoanalysis, Total War and the Making of the Democratic Self in Postwar Britain (Cambridge University Press, 2013).

 

Conference – DSM: The History,Theory, and Politics of Diagnosis. University of Surrey, Guildford, 25-27 March 2013

DSM: The History,Theory, and Politics of Diagnosis

 

CALL FOR PAPERS

History & Philosophy of Psychology Section
Annual Conference
25-27 March 2013
University of Surrey, Guildford

Keynote Speaker: Professor Ian Parker

2013 marks the 40-year anniversary of the vote by the members of the American Psychiatric Association to remove ‘homosexuality’ from its Diagnostic and Statistical Manual (DSM). 2013 is also the publication date of the fifth edition of the DSM.

To mark this anniversary and this event, the History and Philosophy Section have themed the 2013 conference ‘DSM:The History,Theory, and Politics of Diagnosis.’

Individual papers or symposia in any area dealing with conceptual and historical issues in Psychology, broadly defined, are invited.

The conference is open to independent and professional scholars in all relevant fields, not just Section or British Psychological Society members. A limited number of bursaries will be available to students who have had their paper accepted for presentation.

All submissions (abstracts of 200 words) should be sent via email to Dr Geoff Bunn: g.bunn@mmu.ac.uk by Friday 14 December 2012. Further information is available on the Section’s website: http://www.bps.org.uk/history/events/events_home.cfm

UN – Global Mental Health, WHO Action Plan, Oct. 11, 2012

The NGO Committee on Mental Health

Affiliated with the Conference of Non-Governmental Organizations (CoNGO)

in Consultative Relationship with the United Nations

presents

In Commemoration of World Mental Health Day

 

“Global Mental Health, WHO Action Plan 2013-2020:

Integrating Physical and Mental Health”

 

 

The World Health Organization (WHO) projects that depression will be the number one global burden of disease by 2030, surpassing heart disease and cancer, and anticipated to be the number two burden by 2020. The 2011 UN Summit on Non-Communicable Diseases (NCDs) addressed the rapid increase of chronic illnesses and the need to focusing on primary care to develop effective prevention and intervention steps, including the need for behavioral and mental health strategies.  The May 2012 World Health Assembly Resolution to develop country wide mental health programs and the drafting of the recent draft WHO Global Mental Health Action Plan to implement strategies are essential to curbing this looming epidemic, as well as from the trauma and emotional disorders arising from violence, war, and conflict that not only threaten global well-being, but the economies of all nations.

 

Thursday, October 11, 2012

2:00-4:00 PM

U.N. Church Center

777 United Nations Plaza, New York City, NY

44th Street and First Ave.

2nd Floor Conference Room

Please RSVP to mentalhealthngo@optonline.net

 

MODERATOR  AND INTRODUCTIONS

Dr. Elizabeth Carll

Chair, NGO Committee on Mental Health; U.N. Representative, International Society

for Traumatic Stress Studies; President, CCCUN

INTRODUCTORY REMARKS

Dr. Jacob Kumaresan

Executive Director

WHO Office at the United Nations, New York; WHO Action Plan for Mental Health 2013-2020

 

Adama Diop,

First Vice President, Conference of NGOs (CoNGO)

 

PARTICIPANTS

H. E. Dr. Josephine Ojiambo – Keynote

Ambassador and Deputy Permanent Representative

Republic of Kenya to the United Nations

 

Dr. Gabriel Ivbijaro 

Chair, Waltham Forest Clinical Commissioning Group, London; Joint editor Wonca/WHO -“Integrating Mental Health into Primary Care: A Global Perspective”; Europe Vice President, WFMH

 

Terrie M. Williams

Founder/President, Terrie Williams Agency; Mental Health Advocate; Author, “Black Pain: It Just Looks Like We’re Not Hurting” led to national mental health advocacy campaign “Sharing Ourselves..Healing Starts With Us”

 

GROUP DISCUSSION – AUDIENCE Q & A

Further information contact mentalhealthngo@optonline.net

Co-sponsored by

  Communications Coordination Committee for the United Nations (CCCUN);  International Council of Women (ICW);  National Council of Women-USA;  World Federation for Mental Health (WFMH); International Society for Traumatic Stress Studies (ISTSS); International Council of Psychologists (ICP);  NGO Committee on Ageing; NGO Committee on Sustainable Development; International Association of Applied Psychology (IAAP);  World Council of Psychotherapy;  International Union of Anthropological and Ethnological Sciences;  International Association of Schools of Social Work;  Human Rights Congress for Bangladesh Minorities (HRCBM); NGO Forum for Health, Geneva  

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

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).

 

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