Archive for the ‘ books ’ Category

Review – Michal Shapira, The War Inside: Psychoanalysis, Total War, and the Making of the Democratic Self in Post-War Britain (Cambridge 2013)

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Paul Lerner, University of Southern California

The psychological impact of modern war on civilians remains a little studied topic, even as the already prodigious historical scholarship on war trauma continues to expand rapidly. Michal Shapira’s recent book makes great strides in redressing this gap, vividly depicting the emotional strains of war on women, children and other non-combatants and revealing the enormous and sustained expert attention the topic received in Britain in the 1940s and beyond.  Dealing with populations such as juvenile evacuees during Germany’s brutal air assault, Jewish children rescued from Nazi-controlled Europe, and civilians separated from their loved ones in uniform, thrust psychoanalysts, a group once reticent about taking political stands, into public debates about mental health, trauma, and child development.  Indeed, Shapira shows that as Britain sought to emerge from the war as a stable, intact and democratic society in a devastated and fiercely divided Europe, psychoanalysts became key contributors to general discussions about the family, violence, criminality and sexuality.

Shapira frames these discussions broadly, drawing on Nikolas Rose’s Foucault-inspired work on the historicitiy and constructedness of the modern self, indeed furthering his argument that the individual with psychological depth and an “inner life” emerged in the middle of the twentieth century, due in part to the emergence of the “psy” disciplines.  Shapira builds on this insight with parallel interventions in the history of childhood, focusing on a crucial transitional moment from Victorian attitudes toward children as pure and innocent to more modern, developmental and psychologically-nuanced ideas, which saw childhood more as a precursor to adulthood where nascent sexual urges, aggression, and psychodynamic conflicts leave a lasting imprint on the psyche.  Child rearing and education then became bound up with Britain’s larger national project of emerging from the trying ordeal of war and returning to a normal domestic order.  This order, propped up by psychoanalysts, social scientists and the postwar social democratic state, involved re-inscribing traditional gender roles and emphasizing the centrality of the mother to healthful child development and domestic tranquility.

A great many of these elements can be traced back to the First World War and the interwar period.  Shapira’s first chapter goes back to that era to argue that wartime experiences helped chip away at the strict division between healthy and pathological psyches, and most significantly, that medical and psychological professions became more accepting of fear and anxiety as normal, healthy reactions to wartime experiences.  Psychoanalysts in particular played a pronounced role in this shift.  Their work with war neurotics, along with Freudian ideas about trauma, helped remove the stigma from sufferers of anxiety-induced conditions.  By the beginning of World War II, Shapira argues, these changes had taken root in lay attitudes as well, and amid Germany’s aerial bombing campaigns, many Britons openly expressed their terror and anxieties or confided them to psychologists frankly and without shame.

Most of the book’s subsequent sections focus on children as subjects of psychological treatment and expert intervention.  Its second chapter foregrounds the work Anna Freud and other psychoanalysts conducted with child evacuees and refugees.  Here the theme of the “war inside” begins to emerge, as contemporaries equated the potentially traumatizing consequences of bombardment, violence and separation with the internal turmoil of the child’s psyche.  For Anna Freud, then, violence and aggression were normal childhood tendencies, stages that all children navigate through as part of the maturation process.  The problem then was not that war-produced violence threatened to shatter fragile, beatific babes, rather that external violence could stunt children’s psychological development, that it could seem like a normative state and that kids therefore would not learn how to manage their emotions and overcome it.  Plumbing rich collections of case histories, Shapira tells of children equating German military aggression with adult anger, or bombing with parental punishment, suggesting the extent to which external danger and internal dynamics were intertwined.  The solution lay in (re)-establishing parenting and familial bonds which Anna Freud and her colleagues saw as crucial for the resolution and management of these childhood conflicts.

The famous Anna Freud – Melanie Klein dispute takes center stage in the third chapter, in which Shapira covers tensions between the existing British psychoanalytic community and the newer cohort of Central European émigré analysts.  As is familiar to scholars of psychoanalysis, Melanie Klein considered children’s play to be akin to adult psychoanalysis, in other words a setting for transference, rife with symbolic meanings for the analyst to decode. Freud viewed this notion skeptically, doubting that children were sufficiently psychologically developed for these dynamics and emphasizing instead the need for corrective pedagogy, betraying her indebtedness to Austrian educational theory from the 1920s and 30s.  Shapira’s contribution to the historiography of this debate is to call attention not to the disparity in the two positions, but to stress the common ground between the famous rivals (and the many “independent” analysts in the middle), in their shared representation of the emotional dynamics of childhood and the articulation of psychoanalytic therapeutics for children.  Shapira credits Klein with playing a crucial role in the creation of modern selfhood as she developed a deep psychological approach to understanding the impact of war and violence, in implicit contrast to the more sociological analyses of Erich Fromm and his Frankfurt School colleagues or the more materialist and mechanical theories of mainstream psychology and psychiatry.  Her key point here is that despite their theoretical and clinical differences, together Freud, Klein and others turned the child into an object of technical expertise and state intervention and made their care a matter of national concern.

The fourth chapter broadens out to the popularization of psychoanalytic expertise, which Shapira traces through a series of radio broadcasts created by Donald Winnicott and the BBC between 1943 and 1966.  Detailing the collaboration between Winnicott and his BBC producer Janet Quigley, she shows how psychoanalytic ideas about child development buttressed the new emphasis on family in postwar Britain and placed responsibility for children’s emotional wellbeing firmly on the mother, a theme she takes up again near the book’s end.  Winnicott and his BBC sponsors thus fed into postwar pronatalism and the emerging conception that the family was the bedrock of a healthy democratic state.  The gender-political implications of this stance are clear, and given the mobilization of British women in the armed services and wartime work, psychoanalytic expertise here served the larger political aim of bringing women back into the domestic sphere and blaming working women for their children’s emotional struggles.

Chapters five and six treat the Institute for the Scientific Treatment of Delinquency (ISTD) first during the war and then amid the establishment of the postwar “therapeutic” welfare state.  Here she traces the transition from more punitive approaches to a new emphasis on treatment and rehabilitation, in part, due to the influence of psychoanalysts who were strongly represented in the ranks of the ISTD researchers.  No less a figure than Sigmund Freud himself, along with Ernest Jones, Otto Rank and Carl Jung, among others, served as ISTD vice presidents.  Criminality represents a kind of bridge, an issue which brought psychoanalytic perspectives on childhood and development into the public sphere and into the administrative apparatus of the postwar welfare state.  As she moves into the postwar period, her discussion shifts to issues like prostitution, homosexuality and deviance.. Shapira elucidates the psychoanalytic side of the discussion but also surveys the work of state officials, social scientists and members of the judicial system, revealing that not only were psychoanalysts addressing these issues, but that people in power were listening to them.  Consequently, the postwar years saw a broader acceptance of psychological, as opposed to moral or economic, approaches to crime and deviance.

In her concluding chapter on child hospitalization and attachment theory, Shapira comes full circle.  Having begun with the evacuation of children during wartime bombing and their resulting separation from their parents, she ends with the broader embrace of the salubriousness of the  mother – child bond, as demonstrated, for example, in the reversal of older policies that kept hospitalized children sequestered from their mothers and fathers.  Using media sources and letters from parents, she is able to document the wider diffusion of psychoanalytic ideas about childhood and parenting not only in official circles but also among the general public.  Indeed this book’s varied source base is one of its great strengths.  Based on case histories, archival sources, professional journals, and radio, television and newspapers, the book operates on many levels and provides a broad overview of many of the ways a psychoanalytic sensibility crept into public discourse in these years and meshed with the goals of the nascent welfare state.  At the center of their concerns was of course the mother and the importance placed on her presence as a domestic anchor, the fundament of the healthy family and the restored nation.

Carefully researched and tightly argued, this book makes broad and intriguing claims about postwar British subjectivity and the origins of modern, psychoanalytically informed notions of the self.  While generally persuasive, these claims could have been further substantiated with additional discussion of British political culture.  Whereas Shapira gives some attention to the ascent of Labour after the war, she completely neglects the loss of empire which, as other historians have argued, was deeply intertwined with the emergence of the welfare state and which certainly influenced notions of Britishness, citizenship and selfhood in the postwar period.  Parallel to her discussions of sexuality, gender and the family in the reconstitution of British political life, including race and post-imperial identity could have deepened the analysis and broadened its appeal.  It would also have been interesting to place the British case, at least speculatively, in a broader context with some acknowledgement of parallel developments in North American and on the European continent.  These points notwithstanding, The War Inside is a vital addition to the study of psychoanalysis and its diffusion, the history of childhood, and the rise of the therapeutic-administrative state.  It successfully gets at the fundamental but extremely elusive process by which our emotions, feelings, and drives became things for us to manage, part of the individual’s project, helping show how the modern self emerged from the rubble of the middle of the twentieth century.

New book – Therapeutic Fascism. Experiencing the Violence of the Nazi New Order

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The book Therapeutic Fascism: Experiencing the Violence of the Nazi New Order by Ana Antić could be of interest to H-madness readers. This information was retrieved from la vie des idees who published a review about this book. The abstract on the website of Oxford University Press reads:

During World War Two, death and violence permeated all aspects of the everyday lives of ordinary people in Eastern Europe. Throughout the region, the realities of mass murder and incarceration meant that people learnt to live with daily public hangings of civilian hostages and stumbled on corpses of their neighbors. Entire populations were drawn into fierce and uncompromising political and ideological conflicts, and many ended up being more than mere victims or observers: they themselves became perpetrators or facilitators of violence, often to protect their own lives, but also to gain various benefits. Yugoslavia in particular saw a gradual culmination of a complex and brutal civil war, which ultimately killed more civilians than those killed by the foreign occupying armies.

Therapeutic Fascism tells a story of the tremendous impact of such pervasive and multi-layered political violence, and looks at ordinary citizens’ attempts to negotiate these extraordinary wartime political pressures. It examines Yugoslav psychiatric documents as unique windows into this harrowing history, and provides an original perspective on the effects of wartime violence and occupation through the history of psychiatry, mental illness, and personal experience. Using previously unexplored resources, such as patients’ case files, state and institutional archives, and the professional medical literature of the time, this volume explores the socio-cultural history of wartime through the eyes of (mainly lower-class) psychiatric patients. Ana Antic examines how the experiences of observing, suffering, and committing political violence affected the understanding of human psychology, pathology, and normality in wartime and post-war Balkans and Europe.

Book review – Spannungsherde. Psychochirurgie nach dem zweiten Weltkrieg

Screenshot from 2016-05-31 13-41-34Von Viola Balz

Ende August 1946 reiste Manfred Bleuler, Leiter der Züricher Universitätspsychiatrie Burghölzli nach Skandinavien und ließ sich dort eine größere Zahl von leukotomisierten Fällen zeigen. Von seinem klinischen Eindruck der dort operierten Patient_innen überzeugt beschloss er schließlich, die Eingriffe auch in der Schweiz durchzuführen. Marietta Meier macht die Debatte um die Psychochirurgie in der Schweiz zum Ausgangspunkt ihrer Monographie, ergänzt diese aber auch durch Diskurse aus dem europäischen Ausland. Damit legt sie erstmals eine Untersuchung der Psychochirurgie im deutschsprachigen Kontext vor. Während sich zwei bekannte US-amerikanische Studien aus den 1990er Jahren vor allem der Frage nach der Entwicklung therapeutischer Verfahren in der Psychiatrie von den frühen Versuchen bis zur verifizierten Therapie und der Frage nach der Co-Konstruktion der Effektivität der Leukotomie durch Arzt und Patient in der klinischen Praxis widmen,   fragt Meier nach der Metapher des „affektiven Stachels“, also der Frage, wo der Stachel der affektiven Spannung steckt: Was empfand man in der Nachkriegszeit als Stachel, was sollte durch einen psychochirurgischen Eingriff entfernt werden? Marietta Meier versucht dieser Frage mit Foucaults Konzept der Problematisierung nachzugehen. Diesem Konzept folgend analysiert die Autorin, wie und warum bestimmte Phänomene zu einem Problem wurden. Dabei untersucht sie vor allem drei Ebenen: Zuerst fragt sie, auf welche Umstände die Leukotomie eine Antwort geben sollte, darüber hinaus möchte sie wissen in welchem Wechselverhältnis Kontinuitäten und Wandel, Ordnung und Veränderung hier miteinander stehen ohne diese zugleich als chronologische Abfolge begreifen zu müssen und schließlich möchte sie anhand von Quellen aus unterschiedlichen Kontexten wie Publikationen und Krankenakten herausarbeiten, welche unterschiedlichen Facetten debattiert und welches Verhalten je nach Kontext zum Problem wurde. Die Autorin versteht ihren Ansatz dabei als kulturhistorischen, der danach fragt, wie die Akteure ihrem Handeln Sinn verleihen (S. 17-19). Meier gliedert ihre Untersuchung dabei in neun Kapitel. Im ersten Kapitel schildert sie die Einführung des Verfahrens in der Schweiz und die ersten Behandlungsfälle und kontextualisiert diese insbesondere mit den somatischen Verfahren. Das zweite Kapitel widmet sich der Frage, wie die Psychiater_innen sich die Wirkung des Verfahrens erklärten. Dabei arbeitet Meier heraus, dass die Psychochirurgie sich erst dann weiter durchsetzen konnte, als eine wissenschaftliche überzeugende Begründung vorgelegt werden konnte. Argumentierte der „Entdecker“ der Psychochirurgie, der Portugiese Antonio Egas Moniz noch damit, mit dem Eingriff fixierte Nervenbahnen zu durchtrennen und verortete die Technik deshalb in einer vielen Psychiater_innen als veraltet geltenden Lokalisationslehre, gelang es den amerikanischen Psychiater_innen Freemann und Watts schließlich ein Erklärungsmodell vorzulegen, das auf die Verbindung von Thalamus und Frontallappen als Regulationsinstanz für die Intensität von Gefühlen rekurrierte und auf die Unterbrechung der affektiven Spannung durch die deren Durchtrennung hinwies. Diese Verbindung des Verfahrens mit der Beeinflussung von Emotionen sorgte nach Meier dafür, dass sich die affektive Spannung als boundary concept zwischen Hirnforschung, klinischer Forschung und psychiatrischer Praxis durchsetzen konnte. Im dritten Kapitel beschreibt Meier die Verbreitung der Leukotomie in Europa und insbesondere in der Schweiz als Folge der aktuellen Probleme der Nachkriegspsychiatrie, die wiederholt für eine Überfüllung der Anstalt sorgte und deshalb die affektiven Spannungen der Patient_innen verstärkte und in einem neuen Licht erscheinen ließ. Anschließend diskutiert sie im vierten Kapitel die wissenschaftliche Debatte zur Psychochirurgie. Dabei wurde v.a. über den Preis der Eingriffe ins Gehirn, die schon damals als letzter Behandlungsschritt galten und selbst von den Befürworter_innen nur mit ca. 1/3 angegeben wurden diskutiert. War ein sozialer Erfolg schon dann erreicht, wenn die Patient_innen weniger störten? Wie bewertete man die damit einhergehende irreversible Persönlichkeitsveränderung? Nicht zuletzt über letzte Fragen diskutierten Psychiater, Philosophen und Theologen kontrovers. Wie und nach welchen Kriterien Patienten der unruhigen Station zum Fall wurden ist Teil des fünften Kapitels. Insbesondere rückt hier ins Zentrum der Analyse, wann die affektiven Spannungen als so schwerwiegend angesehen wurden, dass sie eine Leukotomie rechtfertigten. Meier fragt hier nach der Semantik der Problematisierungen und arbeitet anhand ihres Quellenkorpus von 300 Krankenakten Schlüsselbegriffe heraus und kontextualisiert sie im zeitlichen Verlauf der Einträge um zu zeigen, wie ein kohärentes Bild eines Patienten entstand, der zum Fall für eine Leukotomie werden konnte. Wie dargestellt wird, waren die Erregungszustände der Patient_innen das maßgebliche Argument für einen operativen Eingriff, unabhängig von ihrem sozioökonomischen Status und der Diagnose, denn oft wurden die Patienten vor allem aus der pflegerischen Indikation heraus operiert. Im sechsten Kapitel zum zirkulierendem Wissen widmet sich Meier der Frage, wie die Psychiater_innen den Laien – Angehörigen und der interessierten Öffentlichkeit –den Eingriff zu plausibilisieren versuchten. Gegenüber den genannten Gruppen wurde statt Spannung eher der Begriff der Erregung gebraucht. Besondere Aufmerksamkeit widmet die Autorin schließlich der Frage, warum im Wesentlichen Frauen für einen operativen Eingriff ausgewählt wurden. Sie erklärt diese Entscheidung mit dem Doppelstandard seelischer Gesundheit, der störendes Verhalten von Frauen eine besondere Bedeutung zumaß. Auch kann Meier aufzeigen, dass auf der Mikroebene das störende Verhalten auf den Frauenstationen die Anstaltsordnung erheblicher störte und eine Leukotomie auch der Wiederherstellung dieser Ordnung und der pflegerischen Vereinfachung diente. Das vorletzte Kapitel widmet sich der Produktion wissenschaftlicher Erkenntnisse. Hier gelingt es der Autorin ausgesprochen überzeugend, den Prozess der klinischen Wissensbildung von der Reduktion der differenzierten Schilderung in der Akte in eine kasuistische Berichtsform (Erzählen), der Bildung neuer quantifizierbarer Kategorien aus diesen Kasuistiken (Zählen) und den Versuchen, die Effekte zu verobjektivieren (Lehren) zu verdeutlichen. Im letzten Kapitel beschreibt die Autorin schließlich den langsamen Niedergang der Psychochirurgie im Kontext neuer Behandlungsverfahren. Anders als in klassischen Fortschrittsnarrativen ausgeführt wird, beurteilt sie die Einführung neuer medikamentöser Verfahren in der Psychiatrie in den 1950er Jahren nicht als ursächlich für den Rückgang der Operationen. Viel entscheidender für eine abnehmende Zahl sei ein neuer Denkstil gewesen, der psychotherapeutischen Verfahren eine neue Bedeutung beimaß. Die Autorin schließt ihre Arbeit schließlich mit vier Thesen zur Nachkriegsgesellschaft. Erstens sei die Psychochirurgie als Symptom für die Debatten der Zeit um Technisierung und Entseelung der bewerten. Der Siegeszug der Leukotomie sei nur möglich gewesen, da erstens nach dem zweiten Weltkrieg ein hierarchisches Persönlichkeitskonzept dominierte, dass auf einem vagen, holistischen Persönlichkeitskonzept beruhte. Die Subjektvorstellungen der Zeit habe zudem zweitens die soziale Anpassung höher bewertet als die Individualität des Patienten. Der Kontext des zweiten Weltkrieges habe drittens das Ziel, Krankheiten zu heilen zu der Norm verschoben, Patienten wieder zu funktionierenden Staatsbürgern zu machen. Wie Meier schließt, sei aber viertens von einem diskontinuierlichen Wandel auszugehen, in dem auch kritische Stimmen sich seit den 1960er Jahren wieder Gehör verschaffen konnten.

Meier legt mit dieser Studie eine sehr gut geschriebene, souverän durchgeführte und wissenschaftshistorisch auf dem neusten Stand argumentierende Studie vor. Insbesondere das Konzept der affektiven Spannungen wird als Konzept konsequent umgesetzt. Die Studie sei also jedem, der sich für die Nachkriegspsychiatrie interessiert unbedingt zur Lektüre empfohlen.

Ein Kritikpunkt sei hier dennoch erwähnt: Meier räumt zwar verschiedenen Protagonist_innen in der Diskussion um die Lobotomie (Ärzten, Pflegepersonal, Angehörigen und Laien) einen größeren Raum ein, die Patient_innen selber bleiben aber seltsam stumm bzw. die Patientengeschichten werden eher aus einem ärztlichen Blick geschildert. Lediglich anhand zweier Beispiele versucht Meier einen Einblick in die Selbsterzählungen der Patient_innen zu geben. Dies ist umso erstaunlicher, da die Autorin angibt, dass solche Selbstzeugnisse in ca. 20% der Akten, also ca. 50, vorhanden waren. Das Argument, dass diese Stimmen von den Ärzten zwar gesammelt wurden, für die Entscheidung über die Erfolge einer Lobotomie aber nicht maßgeblich waren und kein Gehör fanden ist zwar vermutlich richtig, überzeugt aber als Argument gegen eine Analyse dieser Dokumente nicht. Diese Begründung verdoppelt die historische Sichtweise der Ärzte und das geschilderte asymmetrische Machtverhältnis eher, statt die Vielstimmigkeit und die unterschiedlichen Sichtweisen transparent zu machen. In gewisser Weise hat die Autorin den Patient_innen damit auch den affektiven Stachel genommen.

Marietta Meier: Spannungsherde. Psychochirurgie nach dem zweiten Weltkrieg. Göttingen: Wallstein 2015

 

Announcement of New Book: Work, Psychiatry, and Society 1750-2010 (ed. W. Ernst)

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The editors at h-madness have received the following notification of a new book due out in a few months:

This book offers the first systematic critical appraisal of the uses of work and work therapy in psychiatric institutions across the globe, from the late eighteenth to the end of the twentieth century. Contributors explore the daily routine in psychiatric institutions and ask whether work was therapy, part of a regime of punishment or a means of exploiting free labour. By focusing on mental patients’ day-to-day life in closed institutions, the authors fill a gap in the history of psychiatric regimes. The geographical scope is wide, ranging from Northern America to Japan, India and Western as well as Eastern Europe, and the authors engage with broad historical questions, such as the impact of colonialism and communism and the effect of the World Wars. The book presents an alternative history of the emergence of occupational therapy and will be of interest not only to academics in the fields of history and sociology but also to health professionals.

(hb 978-0-7190-9769-0 £75.00 January 2016 234x156mm 440pp 20 illustrations, black and white)

Book review – David Frank Allen, Critique de la raison psychiatrique

screenshot-from-2015-03-09-150753L’auteur, maitre de conférences en psychopathologie à l’université de Rennes et psychanalyste, présente ici la réédition d’un texte paru en 1999 dont la démarche historienne est intéressante à plus d’un titre. L’ouvrage est composé comme son sous titre l’indique d’ « éléments » historiques – brève chronologie, courts essais, focus bibliographiques – qui amèneront le lecteur non prévenu contre cette démarche qui peut paraître pointilliste à partager l’objectif salutaire de l’auteur : contribuer à désacraliser le savoir psychiatrique en historisant les catégories qui en fondent l’existence. Plus d’un siècle après son admission dans la classification scientifique, la schizophrénie, c’est-à-dire la démence précoce apparue dans la classification allemande à la toute fin du XIXe siècle, rebaptisée et élargie par Eugen Bleuler quelques années avant la Première guerre mondiale, est évidemment un des objets adéquats pour mener à bien cette mission. A juste titre, David Frank Allen, s’appuie sur la faible stabilité théorique des hypothèses étiologiques la concernant. L’histoire de la schizophrénie apparaît bien comme un « cercle de propositions logiquement contradictoires qui brule sans cesse »(25), caractéristique qui incite l’auteur à faire sienne une maxime debordienne : dans le savoir psychiatrique – ou plutôt le non savoir – le vrai n’est qu’un moment du faux. Continue reading

Book Review – Anne Roekens (dir.), Des murs et des femmes. Cent ans de psychiatrie et d’espoir au Beau-Vallon (Presses Universitaires de Namur 2014)

FMProBy Valérie Leclercq

The psychiatric institution le Beau-Vallon was founded at the eve of the first World War by the catholic order of les Soeurs de la Charité de Jésus et de Marie. Located on one of the hills surrounding the Belgian city of Namur and dedicated to the exclusive care of women, Beau-Vallon was designed as the first pavilion asylum of Wallonia and rapidly developed into an imposing near-autonomous structure isolated from what was seen at the time as the poisonous influence of the city. On the day of its official inauguration in 1924, it was already comprised of eleven pavilions housing a total of 740 patients.
Today, the institution celebrates a century of existence with the release of a book entitled Des murs et des femmes: Cent ans de psychiatrie et d’espoir au Beau-Vallon. Edited by Anne Roekens, a professor of contemporary history at the University of Namur and also the (co-)author of five out of the book’s seven chapters, Des murs et des femmes showcases the penmanship of seven additional contributors, among whom three psychiatrists (Xavier de Longueville, Benoît Delatte and Jean-Paul Rousseaux, responsible for the seventh chapter), three young historians graduated from the Catholic University of Louvain (Nathalie Collignon, Lisa Lacroix and Mélanie De Brouwer) as well as historian Benoît Majerus who has published extensively on the history of psychiatry in Europe these last few years. The book also incorporated elements from the work of students from the UNamur history department who in 2012 and 2013 were given the opportunity to delve into the records of the institution.
Thematically structured, Des murs et des femmes explores different aspects of the history of the institution, from the context of its foundation to its present state, from its evolving spatial infrastructures and treatment procedures, to the specificities of its personnel and patient population. The book does a great job at revealing the slow processes behind some of the important changes that radically affected 20th-century psychiatry, such as the apparition of psychopharmacology, the professionalization and secularization of the medical personnel, deinstitutionalization, etc. Surprisingly, the history of Beau-Vallon (which would have been considered a second-class country asylum – ou “asile de province” – by the medical authorities of the capital) parallels that of western psychiatry more closely that one might think. In one instance it even seems to have anticipated change when the institution opened several residential facilities outside the hospital a decade before the launch of the 1991national plan to encourage the development of ‘MSP’ (Psychiatric Care Houses) and ‘IHP’ (Protected Homes Initiatives). This last fact the authors are of course eager to point out. But Des murs et des femmes is far from being the simple celebratory narrative that one might expect. Although never overtly critical of this particular institution, the authors do not shy away from sensible topics such as forced confinement, physical coercion, unresponsive physicians, suicide or social segregation inside the asylum, etc. The tone of the book is globally that adopted by most medical historians today who cautiously navigate between the radical anti-institutional acidity of the 60s/70s and the blind optimism of Whiggish medical-historical writing. This middle way is apparent when the authors expose the mutability of the totalitarian psychiatric space, recontextualize the use of mental therapeutics or brush aside the rigid physician-patient antagonism to highlight what Benoit Majerus in his book Parmi les fous (2013) already deemed the central relationship of the everyday institutional psychiatric experience: that of nurses and patients.
Des murs et des femmes, however, will probably prove a frustrating read for historians of psychiatry due to a somehow limited depth of analysis. It propounds no really innovative thesis. The book might be in this regard illustrative of a certain Belgian francophone approach to history: close to its rich source material but lacking in theoretical background and perspective. The two first chapters (Le temps des fondations & Espaces psychiatriques, espaces religieux) appear the strongest and tightest while the four following chapters, dealing respectively with the two world wars, the patient population, treatment and the asylum personnel, seem a bit more factual and loosely problematized. The last chapter, which is concerned with deinstitutionalization and was penned by the three medical authors, confidently recounts the progressive opening of Beau-Vallon and the evolving Belgian legal context in many interesting and necessary details but without never really questioning the process of deinstitutionalization itself. To be fair, the very nature of the project must have imposed some limitations to the contributors’ creativity. When medical historians decide to work on the records of a single medical institution, it is usually to study some or other aspects of medicine or psychiatry, and they are then usually free to narrow their focus as they think best for the relevance of their subject. In The Psychiatric Persuasion, for instance, Elizabeth Lunbeck used the records of the Boston Psychopathic Hospital to write about the psychiatrization of everyday life, just as a few years earlier Nancy Tomes in The Art of Asylum-Keeping dug through the archives of The Pennsylvania Hospital for the Insane only to reflect about the social significance of mid-19th century asylums [1]. But Des murs et des femmes is ultimately the history of the Beau-Vallon asylum itself, an object uneasily unified around a cardinal analytical argument. The study, as a result, covers the major aspects of the institution’s evolution in a thematic overview that still seems to have a lot of unexplored potential.
It is great, however, to see a medical institution collaborate with historians and work such as this being commissioned. And despite its limitations, Des murs et des femmes seems to achieve its purpose successfully. It is a carefully researched and well written effort that is also accessible for the layperson. This accessibility would seem essential for a centennial anniversary publication. The source material used by the different authors is incredibly rich and varied; it includes congregational and hospital archives, legislative texts, medical literature, private archives, oral history (most interviews have been conducted by Anne Roekens), photographs, etc. Moreover, long excerpts from archival documents are showcased in dark grey sidebars, giving the reader direct access to the words of various actors from the period – whether it be catholic nurses or nursing students, psychologists, a priest or a judge. This makes for an engaging read that will similarly please the general, medical and historian public. It is also worth noting that the history of sciences and medicine in Belgium is still in its infancy. In this regard, any contribution to this field is highly valuable, especially when it points out, as is the case here, the specificities of the Belgian situation (for instance the predominantly religious and hospital-centered character of 20th century Belgian psychiatry), possible archive material and new territories to explore while contributing to building the picture of a larger national historical context that no reference work has yet come to illuminate.
1. Elizabeth Lunbeck, The Psychiatric Persuasion : Knowledge, Gender, and Power in Modern America, Princeton: Princeton University Press, 1994; Nancy Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry, Philadelphia: University of Pennsylvania Press, 1994 (origin. ed. 1984)

 

Valerie Leclercq is a FNRS doctoral Research Fellow at the Free University of Brussels. Her areas of interest include 19th and 20th-century medicine, the history of patients, psychiatry and medical ethics. She is currently writing her dissertation on the therapeutic encounter at the turn of the 20th century.

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).

 

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