This blog follows the history of psychiatry

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Elizabeth Lunbeck is co-editor of H-Madness and  a historian of psychiatry and psychoanalysis. She is the author of The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton 1994,  1996), and, with the psychoanalyst Bennett Simon, of Family  Romance, Family Secrets (Yale 2003).  She has co-edited several additional volumes, most recently Histories of Scientific Observation, with Lorraine Daston (Chicago, 2010).  At present, she is completing The Americanization of Narcissism.  Grants and fellowships from  the John Simon Guggenheim Memorial Foundation, the National Institutes of  Health, the National Endowment for the Humanities, and the Charles Warren Center, among others, have funded her research and writing. Lunbeck is Nelson Tyrone, Jr Professor of History, and Professor of Psychiatry, at Vanderbilt.

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Greg Eghigian is co-editor of H-Madness and Director of the Science, Technology, and Society Program (on leave 2010-11) and Associate Professor of Modern History and Science, Technology, and Society at Penn State University (USA).  He writes and teaches on the history of madness, mental illness, and mental health in the western world.  He is the co-editor and author of numerous books, most recently From Madness to Mental Health;  Psychiatric Disorder and its Treatment in Western Civilization (Rutgers University Press, 2010).

The course I teach is one I designed from “scratch,” so to speak.   By that, I mean that there was no such course on the books at my university when I first started out.  So, I needed to build the course from the ground up.

From the start, I was faced with choices.  What time period should the course cover?  What geographical region or regions?  Would the focus be on medicine and psychiatry, or would it integrate broader social and cultural aspects?  Should the course be for advanced students majoring in history, or should it target non-history majors?

I decided pretty quickly, however, that the course should be an introductory level and one that would attract students from across the university.  It’s important,  I think, that students think about history as more than just the story of kings, queens, wars, political developments, and social movements.  These are all important matters, to be sure, but thematic dimensions of human history can also provide an important window into how and why the world has come to appear the way it does.  But beyond this, I was (and remain) less interested in the prospect of luring history majors to the course than bringing in students majoring in psychology, pre-med, life and health sciences, and the social sciences.  One of my chief purposes, then, is to get future clinicians, caretakers, researchers, and policy makers to consider what an historical perspective might say about the choices made and not made along the way in the development of social and medical thinking about and responses to madness.  This is accomplished institutionally, at least, by ensuring that the course satisfies the “general humanities” requirement that students in non-humanities fields must meet.

Thus, I designed and teach the course as an introduction to the long history of (ancient times to the present) of madness and mental health.  There are restrictions and limitations, however.  I focus exclusively on the “western” world, meaning Europe (including Russia and Great Britain), European colonies, and the United States.  I try to be sensitive to non-western perspectives and global change, but, alas, there is only so much I know and can present.  In the ancient and medieval periods, I make a point of discussing the roles of Judaism, paganism, Christianity, and Islam, but the course has an increasingly secular focus as we move into the modern period.  Developments since the 18th century are the main focus of the course, due, in part, to my own interests, but also due to the fact that I believe students are eager to learn about the 19th and 20th centuries.

The course in its present form is relatively large, ranging in recent years from 140 to 220 students.   At Penn State, this means that the course has a fixed structure: two large lectures a week, combined with smaller discussion sections taught by graduate teaching assistants every Friday.   My lectures are fairly straightforward PowerPoint presentations, punctuated by films now and again.  The focus of the Friday sections is on primary sources.  The graduate TAs and I meet once a week to analyze and talk about the week’s primary sources, flagging the main themes to be addressed on Friday.

Originally, when I taught the course, the primary sources were provided to the students in the form of a photocopied reader.  The course, however, inspired me to “take the plunge” and edit a primary source reader, now being published by Rutgers University Press (thanks to former TA Deirdre Fulton for lighting a fire under me).

Something I later integrated into the book I’ve edited is the periodization of the course. I break the course down thematically as well as chronologically.  The longest period I call the Pneumatic Age (from ancient times to the 18th century) – from the ancient Greek concept of “pneuma” – when madness was seen and treated as both a spiritual and somatic affliction.  The second period, running from the second half of the eighteenth through the 19th century, I deem the Age of Optimism.  Here, the emphasis is on institutional and treatment reforms as well as the growing importance of academic science and research.   The third period – from around 1914 to the 1970s – I refer to as the Militant Age, a period when heroic medicine and radical projects came to dominate psychiatric work.  Finally, a period from around the middle of the 20th century to the present I refer to as the Psychoboom.  This is a time when a wide array of psychotherapies entered the marketplace, coupled with a precipitous rise in the number of mental health professionals.

Without question, there are advantages and disadvantages to covering such a lengthy period of time.  It is difficult to give the most recent developments the time they deserve: student (and instructor) fatigue sets in at the same time that one begins to take on the contemporary period.  And, of course, it is pretty much impossible to delve into any one issue in detail.  In the end, however, I believe much more is gained by spending considerable time on the pre-modern.  By taking students out of the comfort zone of modernity and encouraging them to see the world through ancient, medieval, and early modern eyes, it is perhaps a little easier to think about the present in novel ways.

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Rhodri Hayward is Wellcome Award Lecturer in the History of Medicine at Queen Mary, University of London, where he works closely with the Centre for the History of the Emotions. His current research examines the rise and political implications of psychiatric epidemiology in modern Britain.  He has published on a wide variety of subjects including the history of dreams, Pentecostalism, demonology, cybernetics and the relations between psychiatry and primary care. His book, Resisting History: Popular Religion and the Invention of the Unconscious was published by Manchester University Press in 2007. He has recently completed a second book, Self Cures, on the relationship between psychology and medicine in modern Britain.

‘Madness and Medicine in Modern Britain’ was first developed as a masters course at the University of East Anglia, where it proved popular among creative writing students in search of fresh material. Over the last few years it has been taught as a second or third year undergraduate option to history students and is usually oversubscribed.  At first glance the course appears rather parochial. It offers a linear narrative history of psychiatry in Britain from the building of the first state-sponsored asylums through to their closure under the Tory governments of the 1980s.  However within this narrative strong emphasis is placed on the legal origins of psychiatric categories, the changing bases and rationalisations of medico-psychological practice and the implications that these changes carry for the understanding of selfhood and interpersonal relationships.

In my experience the narrative format works very well.  Although it runs the risk of reifying certain medical developments it does bring out the contingency of psychiatric ideas and students are well able to understand the social and political factors that contribute to classifications, treatments and theories.  An ongoing disappointment is that where once students turned to these seminars for political insight, they are now more likely to treat classes as a kind of therapeutic forum in which they use historical materials to reflect upon their personal problems.  I once hoped that this course would help them see their problems, are in the last analysis, political.  I am no longer convinced that this will happen.

This is another installment in our series on university and college courses dealing with the history of madness, mental illness, and psychiatry.

Geoffrey Reaume is Associate Professor in the Critical Disability Studies graduate program at York University, Toronto, where he has taught since 2004. He has written two books: Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940 (Oxford University Press Canada, 2000; re-issued, University of Toronto Press, 2009, 2010); and Lyndhurst: Canada’s First Rehabilitation Centre for People with Spinal Cord Injuries, 1945-1998 (Montreal & Kingston: McGill-Queen’s University Press, 2007). Reaume is a co-founder of the Psychiatric Survivor Archives, Toronto (founded 2001), has given over 80 history tours of the patient built nineteenth century Toronto Asylum boundary walls at the Centre for Addiction and Mental Health based on research from “Remembrance of Patients Past” and introduced and has taught Mad People’s History at all three universities in Toronto.

The purpose of Mad People’s history is to understand the history of madness from the perspectives of people who have lived this past. Its purpose is also to engage this history with students who have or are currently experiencing madness, either themselves or in relation to relatives and friends. In particular the course is intended to provide an alternative to the medical model perspectives which have dominated the history of psychiatry. The use of the term “Mad People” in the title is intended to ensure it is about the people without whom this history would not exist. It is also intended to ensure that the course is not considered medical model in approach, though people with medical model perspectives are included along with the entire range of perspectives from anti-psychiatry to pro-psychiatry and views that are in between these perspectives.

Generally, the course provides a historical perspective that is highly critical of the medical model for its dominance in modern psychiatry and instead seeks to include broader perspectives that are inclusive of perspectives that interpret madness from wider social influences, such as the impact of poverty, gender, class, race, disability and sexual orientation. The course also seeks to include perspectives that are not only about “famous” mad people but include more sources from people who are less well known so that it is not a “great mad people’s” history course, but rather one which is more broadly representative of the vast majority of unknown mad people. Methodological issues about not being able to access the perspectives of the poorest mad people, who left no writings given their lack of resources and absence of educational opportunities in so many cases, are also discussed to appreciate the limits in understanding this past. The silences in Mad People’s History are thus as important to understand as what we discuss in this course. Finally, connections between past and present are stressed throughout the course to provide context for current developments while appreciating the contributions and experiences of mad people throughout the ages.

An article about this course is available in the journal Radical History Review, 94 (2006): 170-182.