Posts Tagged ‘ Patient records ’

Dissertations –Psychiatry and Society in the German Democratic Republic

Fanny Le Bonhomme: “Psychiatry and society in the German Democratic Republic. Stories of patients from the Charité Psychiatry and Neurology Clinic (East Berlin, 1960–1968)”

Berlin, Krankenhaus, Charité, Psychiatrische und Nervenklinik

Charité Hospital in Berlin, psychiatric clinic (photograph taken on 11 January 1950 by Heinz Funck, located at the Bundesarchiv, Bild 183-S91935 / CC-BY-SA 3.0, Aufn. Illus Funck 5025-50 (3) Mlk 11.1.50)

The patients of the Charité Psychiatry and Neurology clinic (East-Berlin, GDR) during the 1960s are at the center of this study. While taking into account the interpretation provided by the medical discourse, this research aims at reconstructing the experiences and the trajectories of these individuals by inscribing them in the context of the socialist society. Relying on patients’ records – these records being the main source of this study – the goal of this research is to reach a better understanding of underlying tensions in the socialist society in relation to the political and ideological context. As these sources show, when they talk to the therapist, patients can speak according to rules which differ from the rules implemented in the socialist society. Because they may contain traces of speeches that would usually be silenced as a result of censorship or self-censorship, or of the unspeakable, shameful or delirious nature of this speech, the patients’ records prove to be a valuable source for the historian. From marital tensions caused by ideological disagreements to the inner conflicts of an “ardent marxist”, from the pain triggered by the exclusion from the party to the pain caused by the construction of the Berlin Wall, from the “reuniting delirium” to the delusions according to which the West appears as a threat, the individual and singular experiences of the patients allow to reconstruct, through a microhistorical approach, certain tensions inherent to the working of the socialist society.

The thesis was defended on 29 January at the University Rennes 2 (France).

Fanny Le Bonhomme is a post-doctoral researcher at the Centre Marc Bloch (Berlin) and at the Centre for Contemporary History Potsdam (Zentrum für zeithistorische Forschung).

Dissertations – Electroconvulsive Therapy and Its Devices

Max Gawlich: “Electroconvulsive Therapy and Its Devices”

In 1939 a wave of enthusiasm swept through the asylums of Europe. Machines and circuit diagrams originating from Italy, but often only the idea of electrically induced convulsions seized the imagination of psychiatrists. In this dissertation project I study the years of 1938 to 1950 as the period of early adoption and beginning routinization of electroconvulsive therapy (ECT). The history of somatic therapy in mid-century psychiatry remains under-studied, often undervalued as mere precursor of psychopharmacological therapies since the development of Chlorpromazine in the 1950s. On the other hand, next to Lobotomy ECT continues to be the infamous therapy of a disciplining and punishing psychiatric regime, dominating as such the critical discourse about psychiatry since the 1970s. The historical question what ECT was, how the machines were built, what those devices did and how they were adopted in the contexts of asylums remained unanswered.

The study compares three large asylums in Europe which were among the earliest to adopt therapeutic innovations in general and ECT in particular: Eglfing-Haar, south-east of Munich in the German Reich; Münsingen near Bern, Switzerland; and Warlingham Park Hospital in South-London, England. Eglfing-Haar was one of the largest asylums in Europe at the time, infamously known for both its function as relay-station for the transfer of patients into asylums where they would be killed as well as its establishment of so-called starvation units in which patients were murdered through neglect and overdoses of opiates. Münsingen was an internationally acclaimed centre for the so-called somatic therapies like insulin-coma therapy or sleeping-therapy and served as a hub for medically trained refugees fleeing the persecution in the German Reich or Italy. Warlingham-Park Hospital was the first British asylum to adopt ECT besides the Burden Neurological Institute. Its Super-Intendent Thomas P. Rees was famous for his reformist zeal opening the gates of his clinic in 1936.

2013-02-05 11.08.25 (2)

Siemens Konvulsator II – booklet

The source-material of my project is structured mainly by two institutional contexts. First there is the archival material from asylums, meaning mostly patient-files and therapy-registers. The second group are files, correspondence, brochures, and circuit-diagrams created in the development-process either at the Ediswan Co. in Britain or the Siemens-Reiniger-Werke in Erlangen. The opportunity as well as challenge was to develop a framework in which both kind of source materials complement each other and enable new questions and perspectives on clinical therapy with machines in asylums. To achieve this, I focus on 1) records and inscriptions of ECT, 2) the technical evolution of ECT-Devices in the period from 1938 to 1950, and 3) the therapeutic practices utilizing those devices. I further argue that with somatic therapies also the evaluation of those therapies was introduced. Contrary to previous research, my dissertation will show how psychiatrists involved in somatic therapies developed methods to record therapy, add up data and present statistical evidence supporting their claim of clinical success. Not only were the development and utilization of devices deeply entangled, but also questions of dosage, security, or wanted and unwanted effects were technically as well as practically addressed. Institutional settings, personal preferences and the design of ECT –devices produced specific adaptations of ECT in the local spaces of each asylum. The Second World War hindered the exchange of ideas and concepts of ECT, and rather strengthened the position of Swiss psychiatrists as intermediaries in the international transfer of knowledge. The War created a situation of largely isolated developments, producing specific technical and therapeutic solutions, which demands a comparative perspective and explicative approach.

Illustration: SRW Erlangen Technische Entwicklung, Konvulsator II für die Elektrokrampfbehandlung von Psychosen. 1949, in: Veröffentlichungen a.d. Technischen Entwicklung Bd. 4. SRW 1948-1961 p54, Siemens MedArchiv Erlangen, Nr. 71. (Reproduced with the kind permission of the Siemens MedArchiv, Erlangen)

Max Gawlich is a PhD Candidate at the Historical Institute in Heidelberg, were he also studied history and Jewish studies.

Contact: @MaxGawlich on Twitter or max.gawlich@googlemail.com

Témoin de l’histoire de la folie L’archive dans l’institution psychiatrique comme matériel empirique : enjeux méthodologiques et épistémologiques

Credits:Justine Desmond, Wellcome Images

Credits:Justine Desmond, Wellcome Images

Journée d’étude (2 juin 2015)

Institut Universitaire en Santé Mentale de Montréal

7401, rue Hochelaga
Montréal (Québec)  H1N 3M5

Compte tenu des contraintes économiques et spatiales entourant la conservation des archives médicales, une réflexion commune s’impose sur les enjeux et pratiques courantes liés à l’exploitation de ces archives d’une valeur scientifique et sociale incontestable. Or, un dossier médical peut aussi bien parler à un historien, un sociologue, un anthropologue, un psychiatre qu’il renseigne le médecin, l’infirmière ou le patient sur le suivi clinique et les traitements proposés. Généralement devenu caduc pour le personnel hospitalier après la fin du suivi médical, il prend une tout autre importance et signification entre les mains des chercheurs qui y puisent notamment le sens de la pratique médicale d’hier à aujourd’hui, ou encore l’évolution des réactions sociales face aux comportements identifiés comme relevant de problèmes de santé mentale. Ces questionnements seront abordés par des experts internationaux dans le cadre de cette  journée d’étude qui vise à réunir des archivistes, étudiants, chercheurs et cliniciens qui œuvrent dans le domaine de la santé ou de l’histoire.

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Book announcement: “With the mad. A social history of psychiatry in the 20th century” (Benoît Majerus)

H-Madness co-editor Benoît Majerus has a new book out entitled Parmi les fous. Une histoire sociale de la psychiatrie au XXe siècle (“With the mad. A social history of psychiatry in the 20th century”).

The challenge of this book is to tell the story of psychiatry in the 20th century not through psychiatric handbooks or nosological controversies, but through the daily life of one asylum. This approach enables to discover  actors that are still largely excluded from the traditional narrative on psychiatry be it patients but also nurses, social workers… This historiographical gaze gives new readings of classical themes in the field such as the spatial settings of enclosure or the link between knowledge and power. It also questions the chronology by revisiting the so-called chemical revolution in the 1950s or the deinstitutionalisation from the 1960s on.

Patients’ records are a fascinating material to get access to psychiatric practice. The organisation of work, the forms of knowledge, the medical gaze, the experience of mental illness by the patient or the physician are all topics that are too often described and analysed through medical reports or through the published literature in psychiatric journals. Considering these questions from below offers an intriguing insight in the tensions between discourse and practice, between representation of a field and its actual functioning.

This book is part of a larger narrative that goes beyond a historiography of psychiatry still too often entangled in a dichotomous narrative: medical progress or disciplinarisation. Combining micro-history and sciences studies, it hopes to participate in the historicisation of a topic difficult to grapple, but particularly rich for a history of the 20th century through the margins.

To get the two first chapters, click here.

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