International Journal of Mental Health

The most recent issue of the International Journal of Mental Health has a special section dedicated to psychiatry in France. It contains articles on the sectorization system, on users groups, on emergency psychiatry, on university psychiatry, etc.

For more information, click here.

An interview with Jonathan Metzl

Big Think, a website that publishes interviews with a wide range of experts “from hedge-fund managers to neuroscientists”, recently gave Jonathan Metzl the opportunity to resume the main points of his recent book The Protest Psychosis: How Schizophrenia Became a Black Disease.

To listen to the interview, click here.

New Issue of the International Review of Psychiatry

The latest issue of International Review of Psychiatry is dedicated to psychiatry in a colonial context.

Titles, authors and abstracts are listed below.

History of psychiatry in West Africa by F. Oyebode (Department of Psychiatry, University of Birmingham, Birmingham, UK). The abstract reads:

This paper explores the social context of the development of mental asylums in colonial Nigeria. The characteristics of the medical leadership is described, as is the environmental condition of the asylums. The colonial period produced conceptualizations of the African mind and of the pattern and distribution of mental illness in Africans. These conceptualizations are critically examined.

Psychiatry in the East African colonies: A background to confinement by Sloan Mahone (University of Oxford, Oxford, UK). The abstract reads:

This article is concerned with the discipline of psychiatry in colonial East Africa as it emerged out of the crime and disorder problem to become an intellectually significant ‘East African School’ of psychiatry. The process of lunacy certification, in particular, provides a snapshot of the medical and political tensions that existed among the medical establishment, the prison system and the colonial courts, all of whom sought to define collective African behaviour. This historical article utilises archaic terminology, such as ‘lunatic’ or ‘lunacy’, as these categories were in use at the time.

Modern psychiatry in India: The British role in establishing an Asian system, 1858-1947 by J. Mills (Centre for the Social History of Health and Healthcare Glasgow, Department of History, University of Strathclyde, Strathclyde, Glasgow, UK). The abstract reads:

Four broad phases can be traced in the development of modern psychiatry in India. After briefly considering the outline of each of these phases this article will focus its attention on the second and third. It will be argued through tracing the trends in patient admission, treatment regimes and the organisation of the asylum system in these years that the foundations of modern psychiatry were laid in India in the period 1858 to 1947 and that the modern psychiatric system in India as it is today, although it has evolved since Independence in 1947, continues in significant ways to be shaped by the colonial period.

Madmen and specialists: The clientele and the staff of the Lunatic Asylum, Bangalore by Sanjeer Jain and P. Murthy (Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India). The abstract reads:

The history of the asylum has proven to be an invaluable resource for exploring the interface between science, medicine, religion and social and political processes. The definitions of insanity have troubled humans for centuries, as have the methods for treatment. Diverse, and often conflicting, ideological positions are quite common. Documenting the specific histories of the staff and patients of an asylum can thus help us understand the evolution of the physical and the intellectual growth of psychiatry in India. In this endeavour, we have used the records of the Lunatic Asylum, Bangalore (later the All India Institute of Mental Health and subsequently the National Institute of Mental Health and Neurosciences [NIMHANS]) to explore the history of psychiatry in India. The only asylum maintained by a ‘Native Kingdom’, it exemplifies the dynamics of the growth of mental health services in the country. We trace the changes in administrative control of the Asylum, the changes in medical practice and some aspects of the social history of the region. This article traces the history of psychiatry at one institution, which, at the micro level, is a mirror to the understanding of the historical trends of psychiatric services in India.

A brief history of psychiatry in Singapore by B. -Y. Ng (Department of Psychiatry, Singapore General Hospital) and K. -T. Chee (Woodbridge Hospital and Institute of Mental Health, Singapore). The abstract reads:

The development of psychiatric services in Singapore during the last 150 years can be divided into four distinct, albeit overlapping, phases: (1) the origins of the Lunatic Asylum; (2) the interruption caused by the Japanese Occupation, and the post-war years; (3) the training of local psychiatrists and mental health professionals; and (4) the development of general hospital psychiatry and community mental health services. Early psychiatry in Singapore was essentially British psychiatry as an outpost but modified by local conditions. Modern psychiatry in Singapore has its roots in Singapore’s colonial past and is strongly influenced by Western psychiatry. It has come a long way since its humble beginnings when the first mental hospital was established in 1841.

The development of psychiatry in Indonesia: From colonial to modern times by H. Pols (Unit for History and Philosophy of Science, University of Sydney, Sydney, Australia). The abstract reads:

During the colonial period, mental health care policy in the Dutch East Indies was centred on the mental hospital, which provided custodial care. In 1949, independent Indonesia inherited four very large mental hospitals, about 10 acute-care clinics in the major cities, and an agricultural colony. During the 1950s, mental hospital care remained largely custodial. In 1966, the Directorate of Mental Health adopted the three-fold principles of prevention, treatment, and rehabilitation as the foundation of a comprehensive mental health care system. During the 1970s and 1980s, the number of mental hospitals in Indonesia doubled and a variety of treatment methods were introduced. Special attention was given to the care provided by dukuns, or indigenous healers.

Psychiatry and its institutions in Australia and New Zealand: An overview by Catharine Coleborne (Department of History, The University of Waikato, Hamilton, New Zealand) and Dolly MacKinnon (Department of History, University of Melbourne, Australia).

New Issue of History of Psychiatry

The first issue of the History of Psychiatry for 2010 has been released online. Included in this issue are seven articles, which address the madness of King George III, Philipp Pinel, Danish psychiatrist August Wimmer, Jean-Marc Gaspard Itard, William Saunders Hallaran and John Jackson.

Titles, authors and abstracts are listed below.

King George III and porphyria: a clinical re-examination of the historical evidence by Timothy J Peters (Institute of Archaeology and Antiquity, University of Birmingham) and D. Wilkinson (Institute of Education, University of London). The abstract reads:

“The diagnosis that George III suffered from acute porphyria has gained widespread acceptance, but re-examination of the evidence suggests it is unlikely that he had porphyria.The porphyria diagnosis was advanced by Ida Macalpine and Richard Hunter, whose clinical symptomatology and historical methodology were flawed. They highlighted selected symptoms, while ignoring, dismissing or suppressing counter-evidence. Their claims about peripheral neuropathy, cataracts, vocal hoarseness and abdominal pains are re- evaluated; and it is also demonstrated that evidence of discoloured urine is exceedingly weak. Macalpine and Hunter believed that mental illnesses were primarily caused by physical diseases, and their diagnosis of George III formed part of a wider agenda to promote controversial views about past, contemporary and future methods in psychiatry.”

The madness of King George III: a psychiatric re-assessment by Timothy J Peters (Institute of Archaeology and Antiquity, University of Birmingham) and Allan Beveridge (Queen Margaret Hospital, Dunfermline, UK). The abstract reads:

“This research, based on a study of King George III’s medical records and of contemporary diaries of his courtiers and equerries, further confirms the considerable doubt on the claim of Richard Hunter and Ida Macalpine that the King suffered from recurrent attacks of acute porphyria. The present study examines the above records from a psychiatric viewpoint, together with some additional reports, to re-assess the nature of the King’s maladies. It concludes that he suffered from recurrent mania (four episodes), with chronic mania and possibly a degree of fatuity during the last decade of his life. This is in agreement with previous reports that he suffered from manic-depressive psychosis.”

Science and morals in the affective psychopathology of Philippe Pinel by Louis C Charland (University of Western Ontario, Canada). The abstract reads:

“Building on what he believed was a new ‘medico-philosophical’ method, Philippe Pinel made a bold theoretical attempt to find a place for the passions and other affective posits in psychopathology. However, his courageous attempt to steer affectivity onto the high seas of medical science ran aground on two great reefs that still threaten the scientific status of affectivity today. Epistemologically, there is the elusive nature of the signs and symptoms of affectivity. Ethically, there is the stubborn manner in which fact and value are intermingled in affectivity. Both obstacles posed insuperable difficulties for Pinel, who never really managed to extricate his affective psychopathology from the confines of the Lockean intellectual paradigm.”

Wimmer’s concept of psychogenic psychosis revisited by Augusto C Castagnini (University of Cambridge). The abstract reads:

“In the early twentieth century the Danish psychiatrist August Wimmer (1872—1937) developed the concept of psychogenic psychosis (PP) as a category of mental disorders separate from schizophrenia and manic depression. It subsumed a variety of clinical conditions with affective, confusional and paranoid features typically triggered by a psychical trauma. Wimmer’s work has established itself as one of the classic texts in Scandinavian psychiatry but, for linguistic reasons, long remained almost unknown in other European countries. Translated into English in 2003, it is now available for historical and psychopathological analyses. This paper describes the original meaning of PP and sets it in context, then discusses the implications arising from the usage of the diagnostic categories introduced to replace PP in modern international classifications.”

J.-M. G. Itard’s 1825 study: movement and the science of the human mind by Sara Newman (Kent State University, USA). The abstract reads:

“Jean-Marc Gaspard Itard’s 1825 ‘Study of several involuntary functions of the apparatus of movement, gripping, and voice’ discusses 10 individuals with uncontrolled movements but no other significant impairments. Thus, otherwise normal people move in inappropriate ways against their better judgement. Although the study contains the first clinical description of Tourette Syndrome, it has received little attention beyond that notice. Examined in its entirety and in its cultural context, Itard’s study characterizes patients’ movements in terms of the will, propriety, animals and gender. Lacking control over their movements, the individuals are underdeveloped humans. Accordingly, sufferers’ facial expression, bodily movements and unplanned vocalizations render them more animal than human and more deviant than normal, although they are neither insane nor evil.”

Hallaran’s circulating swing by Caoimhghín S Breathnach (University College Dublin). The abstract reads:

“William Saunders Hallaran (c.1765—1825) was physician superintendent at the County and City of Cork Lunatic Asylum for 40 years, where he distinguished between mental insanity and organic (systemic) delirium. In treatment he used emetics and purgatives, digitalis and opium, the shower bath and exercise, and argued that patients should be saved from ‘unavoidable sloth’ by mental as well as manual occupation. However, it is as an exponent of the circulating swing, proposed by Erasmus Darwin and used by Joseph Cox, that he is remembered. His best results were achieved, as he recorded in An Enquiry in 1810, by inducing sleep in mania of recent onset, but perhaps his most enduring observation was that some of his patients enjoyed the rotatory experience, and he had enough sense to allow the use of the swing as a mode of amusement.”

The work of John Hughlings Jackson: Part 1 by JM López Piñero by GE Berrios (University of Cambridge). The abstract reads:

“After returning to Spain from a research period in London on a Wellcome Trust scholarship, José Maria López Piñero1 published in 1973 a short book entitled John Hughlings Jackson (1835—1911), Evolucionismo y Neurología (Madrid, Editorial Moneda). Written from the perspective of the classical German medical historiography that the author had imbibed from Werner Leibbrand and Annemarie Wettley, this work truly added to Jacksonian scholarship. Neither hagiographic nor nitpicking, it offered a sober assessment of the contribution of the great Yorkshireman and it was soon to become a minor classic among connoisseurs. Although important additions to Jacksonian scholarship have appeared since 1973, López Piñero’s book has retained its relevance. It will be published in History of Psychiatry in two parts.”

4th edition of the film-festival Geocinema

The fourth edition of the film festival Geocinema will take place in March 2010 in Bordeaux. This year’s theme is “confinement”. Several films are directly linked to psychiatry such as Shutter Island.

For more information, click here.

Review: Shutter Island

(Note: This review contains plot spoilers).

There are leaks in the ceiling. A storm is brewing. Inside, passageways are dark and twisted, and outside carefully groomed grounds are juxtaposed with ominous cliffs, crashing waves, and inaccessible caves (not to mention rats by the dozen). The setting of Martin Scorsese’s most recent film, Shutter Island, seems to be a hodge-podge of hastily drawn psychoanalytic symbols. Location? The mind of a madman.

Based on a Dennis Lehane novel of the same name, Shutter Island takes place in and around Ashecliffe  Hospital, an institution for the criminally insane located on a New England island. The film opens on a ferry transporting the protagonist, federal marshal Teddy Daniels (played by Leonardo DiCaprio), and his new partner Chuck Aule (Mark Ruffalo) to the island to investigate the mysterious disappearance of a patient who has somehow escaped from a locked cell. Once the missing patient anticlimactically reappears halfway through the film, however, the viewer becomes aware that she is a mere plot device, serving to bring Daniels to the island for the real investigation, which seems to involve secret, experimental surgeries forced on patients in an old lighthouse near Ashecliffe.

The thematic content of Shutter Island draws from a fraught period in the history of psychiatry, incorporating both the transorbital lobotomies made popular across the U.S. by neurologist Walter Freeman as well as the psychotropic drugs that were responsible for the surgery’s decline as the pharmaceutical treatments quickly gained popularity in the 1950s. The transorbital lobotomy (which involves an ice pick-like instrument inserted through the orbit of the eye and into the brain to sever nerve fibers) was performed, at times against a patient’s will (but sometimes with the consent of family), on thousands of people in the U.S., “treating” everything from depression, alcoholism, and unruly personalities to schizophrenia and other diagnosed mental illnesses. The movie depicts the complicated views on lobotomy in the 50s, when some practitioners were horrified at the zombielike patients the procedure produced. Ultimately, the pro-surgery doctors at Ashecliffe have the final say in the “treatment” of the protagonist. The film presents the procedure as a necessary evil in order to protect the staff and patients from Daniels, the asylum’s most violent criminal, whom neuroleptics have not sufficiently subdued.

In Dr. Cawley (Ben Kingsley), Ashecliffe’s primary physician, we are given a third type of psychiatric treatment in the form of psychotherapy. Self-described as a more humane practitioner, Cawley believes in the respect, dignity, and human rights of his patients. The inclusion of these dueling theories increases the stakes for Daniels’ actions as he runs through an elaborate investigation that is stymied by doctors and patients alike. He is eventually told that his partner, Chuck, has been his psychiatrist for the past two years and that everything he thinks is real on Shutter Island is actually an elaborate role-playing exercise constructed to bring him back to sanity and an awareness of his former crimes. The interpretation of his experiences ultimately becomes the focal point of the movie: is he mad or isn’t he? Is the plotline of the missing woman, investigation, and experimental procedures a paranoid delusion, or is he merely being made to believe he is insane to cover up the conspiracy? Although this hackneyed twist has drawn the derision of many reviewers, the film contains nuanced reflections on mental illness that go beyond the old “it was all a dream/it was me/it was a delusional fantasy” revelation. For example, we are confronted in several cases with the idea that once a person has been diagnosed with insanity (or even merely been assumed to be insane), it is nearly impossible for him or her to escape the associations and deprivation of political and personal power that come with such a conclusion. In the film, this of course leads us to further question how we can ever know whether Daniels (a supposedly crazy person who says he isn’t crazy) is or is not insane, but it also provokes consideration of similar diagnoses in contemporary culture—once mentally ill, always mentally ill? The right of interpretation–who determines what is or isn’t sane?–is questioned as well in the character of a woman who killed her husband after he abused her and no one would help. While considered insane by society, she found the action to be completely reasonable in the absence of other options.

Despite the inclusion of multiple forms of psychiatric intervention and constant emphasis of the subtleties of determining the boundaries of the normal, the film also contributes to harmful stereotypes that still circulate in today’s society, leading to the stigmatization and isolation of those with mental illness. The movie both plays on and contributes to the fear of insanity. Some will be quick to write off the portrayal of mental illness as merely an accurate representation of the asylums of a bygone era, but the force of such manifestations should not be discounted in a world where the stigma associated with mental illness is still going strong.  While, of course, some of the horrible experiences of patients in mental hospitals during the twentieth century are well documented, the almost exclusive portrayal of mental illness in movies as something to be feared or reviled propagates modern-day stereotypes that are painfully similar to the historical situations that may have initially inspired them. Although people with mental illness are, as a whole, no more or less violent than the rest of society, the constant portrayal of the insane patient who murders without cause still permeates popular assumptions about disorders of the mind and brain. Shutter Island presents us with anxieties over patients escaping, mauled faces, descriptions of murders the patients committed, and of course the most dangerous patient, our protagonist, a trained soldier who can only be controlled by the “brain death” of the lobotomy. Scorsese does not depart greatly from the pulpy source material, so one could blame Lehane for the cardstock representation of insanity, but Scorsese’s most obvious alteration is just as clichéd and harmful. At the end of the film, just before being carted away to be lobotomized, Daniels delivers this hardboiled line: “Is it better to live as a monster or die as a good man?” That Scorsese has even the patient himself validate the decision to lobotomize speaks to an anxious desire to settle the matter. Of course, the crazed escapee on a murdering rampage makes much better box office fodder than would a more humane representation of the spectrum of mental deviations and psychiatric care, but even so it would be nice to see more films centering on more accurate depictions of mental illness today.

Sarah Birge

Rezension zur Ausstellung Madness & Modernity

Madness & Modernity. Kunst und Wahn in Wien um 1900.

WienMusem Karlsplatz (21.01.2010 – 02.05.2010)

Künstler spezialisieren sich auf „psychologische Portraits“ oder inszenieren sich als „wahnsinnig“, AnstaltspatientInnen betätigen sich künstlerisch, Jugendstil-Architekten planen psychiatrische Kliniken und Mitglieder der Wiener Werkstätte entwerfen Interieurs für Sanatorien – alles Zufall oder Wien um 1900?

Diese Frage geht die Ausstellung „Madness & Modernity. Kunst und Wahn um 1900“ nach. Sie beleuchtet die Wechselwirkungen und Verschränkungen von Psychiatrie, Kunst und Alltagsleben, die – so die Annahme der Kuratorinnen – ein spezifisches Phänomen für Wien um 1900 darstellen. Konzipiert wurde die Schau 2009 für die Londoner Wellcome Collection, deren Ausstellungs- und Vortragsprogramm an der Schnittstelle von Medizin- und Kulturgeschichte anzusiedeln ist. Nach der Präsentation in London ist die Ausstellung nun in Wien zu sehen. Die Schau sowie der dazu erschienene Katalog sind das Ergebnis eines vierjährigen Forschungsprojekts, das am Birkbeck College und an der University of Plymouth angesiedelt war und das die „wechselseitige Beeinflussung von Psychiatrie und bildender Kunst in Wien und der k.u.k. Monarchie in der Zeit von 1890 bis 1914“[1] in den Fokus nahm. Kuratiert wurde die Ausstellung von den Kunsthistorikerinnen Gemma Blackshaw und Leslie Topp.

Die in sechs thematische Bereiche gegliederte Ausstellung geht dem stets ambivalenten Verhältnis von Kunst und geistiger Devianz zwischen Abstoßung und Faszination nach und setzt dabei unterschiedliche Schwerpunkte. Das weite Thema wird durch drei, in unterschiedlichen Epochen wirkenden, sich aber alle auf den Umgang mit psychischen Erkrankungen im 18. Jahrhundert beziehende Exponate eingeleitet: ein Modell des Narrenturms, der 1784 als erste Institution in Wien für psychisch Kranke errichtet wurde, die um 1900 wiederentdeckten Charakterköpfe des Bildhauers Franz Xaver Messerschmidt (1737-1783) sowie eine Videoarbeit aus dem Jahr 2006 von David Bickerstaff, die durch die Gänge des berühmten Rundbaus führt.

Der zweite Bereich der Ausstellung widmet sich der modernen Anstaltsarchitektur der Jahrhundertwende, die in der Umgebung Wiens – so zeigen die Beispiele der Niederösterreichischen Landes-Heil- und Pflegeanstalt Am Steinhof sowie des Sanatoriums Purkersdorf – vom Jugendstil geprägt war. Die um 1907 eröffnete und zu dieser Zeit europaweit größte Anstalt Am Steinhof ist als ein gelungenes Beispiel dafür zu nennen, was zeitgenössische Planer einst `psychiatrische Polytechnik´ nannten. Gemäß dieser ermöglichte erst die Zusammenarbeit von Künstlern, Architekten und – wie es zu diesem Zeitpunkt noch hieß – `Irrenärzten´ die Konzeption eines solchen Großprojektes, dessen Hintergrund darin zu sehen ist, dass der stationäre Aufenthalt als therapeutische Maßnahme an sich galt. Die Ausstellung fokussiert mit Werbeplakaten und Aquarellen spezifischer Räumlichkeiten jenen Teil der vom Jugendstil-Architekten Otto Wagner (1841-1918) entworfenen Anstalt, der für wohlhabende PatientInnen konzipiert worden war: das Sanatorium. Offen bleibt hier die Frage nach der Wirkung der architektonischen Gestaltung vor allem für jene PatientInnen, die seitens der Behörden eingewiesen wurden – denn der Glanz der Anstalt, so evoziert die ausgestellte Türe einer Isolationszelle, richtete sich wohl überwiegend auf die PrivatpatientInnen bzw. auf die BetrachterInnen von außen.

Mindestens ebenso prestigeträchtig ist das wohl als Gesamtkunstwerk anzusehende Sanatorium Purkersdorf, das 1904/1905 von Joseph Hoffmann (1870-1956) – Mitbegründer der Wiener Secession – neu gestaltet wurde. Exponate wie Stühle, Lampen oder moderne Trainingsgeräte zeigen eindrucksvoll, dass die künstlerische Ästhetik bis ins kleinste Detail Einzug in den Sanatoriumsalltag fand.

Sigmund Freud (1856-1939) – dessen berühmte Couch als Leihgabe des Londoner Freud-Museums ausgestellt ist – markiert einen Wechsel im Krankheitsspektrum: Seine psychoanalytische Methode eröffnete gänzlich neue Zugänge im Umgang mit psychischer `Abnormität´. In der Ausstellung wird dies als Moment in den Blick genommen, wo zwischen Kunst und `Wahn´ ein wechselseitiges Interesse Raum greifen konnte. Mit Exponaten wie Egon Schieles (1890-1918) Selbstportraits oder den ‚psychologischen Portraits’ von Oskar Kokoschka (1886-1980) und Max Oppenheimer (1885-1954) wird veranschaulicht, welchen Einfluss der diagnostische Blick, wie er sich unter anderem in der Psychiatriefotografie visuell manifestierte, auf die künstlerische Bildsprache ausübte. Doch nicht nur Künstler der Jahrhundertwende ließen sich von psychiatrischen Forschungen inspirieren – auch PsychiatriepatientInnen betätigten sich künstlerisch. Dass ihre Beschäftigungen um 1900 vermehrt Aufmerksamkeit von Seiten der Ärzte erhielten, wird im letzten Bereich der Ausstellung deutlich. Hier findet sich eine Collage aus Zeitungspapier von Frau St., Patientin der Privatanstalt Oberdöbling, sowie Aquarell- und Gouachebilder von Josef Karl Rädler, der in Mauer-Öhling untergebracht war.

So reduziert die Ausstellung in der Auswahl ihrer Exponate auch ist, so stringent ist der Weg, den sie beleuchtet. Dennoch ist dem kuratorischen Konzept anzumerken, dass dasselbe auf den Endergebnissen eines wissenschaftlichen Forschungsprojekts basiert – an manchen Stellen hätte man sich einen kreativeren kuratorischen Blick gewünscht, der die Exponate nicht nur zum Illustrieren oder Visualisieren bestimmter Forschungsthematiken nutzt. Besser zu verstehen und komplexer wird die Ausstellung erst unter Bezugnahme auf den im Christian Brandstätter Verlag erschienen Katalog, wo beispielsweise auch auf Kontexte der Thematik in der zeitgenössischen Literatur aufmerksam gemacht wird.

[1] Gemma Backshaw/Leslie Topp, Einleitung. In: Dieselben (Hg.), Madness & Modernity. Kunst und Wahn in Wien um 1900. Wien 2009. S. 8-15, 13.

Monika Ankele, Sophie Ledebur

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