Edwin R. Wallace – History of Psychiatry and Medical Psychology

Автор: Edwin R. Wallace
Название книги: History of Psychiatry and Medical Psychology
Формат: PDF
Жанр: История медицины
Страницы: 883
Качество: Изначально компьютерное, E-book

This book chronicles the conceptual and methodological facets of psychiatry and medical psychology throughout history. There are no recent books covering so wide a time span. Many of the facets covered are pertinent to issues in general medicine, psychiatry, psychoanalysis, and the social sciences today. The divergent emphases and interpretations among some of the contributors point to the necessity for further exploration and analysis.

Most of the prefatory issues are extensively elaborated upon in the Prolegomenon, which also contains the
complete references to the texts and authors discussed below.
Nevertheless, the “Preface” would be grossly incomplete without touching on some of these issues,
books, and scholars. Too, many of this book’s chapters (e.g., Mora’s, Marx’s, D. B. Weiner’s) examine and
“reference” important earlier, as well as contemporary, general histories of psychiatry and specialized
monographs; in German, French, Italian, and Spanish. Also, in his 1968 Short History of Psychiatry, discussed
below, Ackerknecht (pp. xi–xii) references important nineteenth and earlier-twentieth century
psychiatric histories in English, French, and German. Such citations will of course not be repeated here.
Finally, thanks to several publishers’ re-editions of dozens of classical psychiatric texts; one can consult
their bibliographies as well. See “Prolegomenon” for references to these splendid series.
In a rough-and-ready sense, medical history began in classical Greece—for example, On Ancient
Medicine. While traditionally included in the Hippocratic corpus, this text seems more likely to have been
written by a non- or even anti-Hippocratic doctor. Moreover, the Hippocratic and other schools were
hardly as secular as we now suppose. On Epilepsy, for example, does not so much declare the prevalent
denotation of it as the “sacred disease” erroneous as it does that it is no more nor less sacred than any other
disease. Historical and archaeological studies of ancient Egyptian, Mesopotamian, Indian, Chinese, and
Greek medicines confirm that they arose first, from a common root with animism and magic; and then
from a close association with religion and the priesthood. Latter nineteenth and twentieth century cultural
anthropologists have found this to be the case in contemporary nonliterate societies as well. The first
medicine to begin secularizing was Chinese—in the immediate post-Confucian period. Moreover, a
propos Western medical historians’ emphasis on the ancient Near East, Greece, and Rome, it is significant
that Indian surgery led the world for quite some time—and that Indian doctors used the rauwolfia root
(i.e., today’s antipsychotic and antihypertensive “reserpine”) to treat certain cases of madness.
Otherwise, the first medical “histories” were simple chronicles of lives of the great doctors and the
movements they founded—often in prefaces or introductions to particular treatises or textbooks. In the
history of medical psychology this was the case as well (see Marx’s chapters for nineteenth century
German examples). These nineteenth century psychiatrist/historians combed the prior medical psychological
literature for alleged “anticipators”—that is, “justifiers”—of their own particular orientations. Hence
their particular psychiatric lens colored their interpretations of earlier doctors and texts; as opposed to the
Rankian historian’s attempt to first enter into and appreciate the earlier figure’s mind-set and text in its
own right before attempting to establish the relationship between prior trends, workers, and texts to recent
and present ones. D. D. Davis, M.D., who translated Pinel’s Treatise on Insanity into English in 1806,
appended a 40-page historical “Introduction” to his translation. The “Introduction” in Esquirol’s twovolume
textbook surpasses the historiography of most of those of his predecessors; and in 1869 René
Semelaigne published what might be called the first true history of the field. The long-lived Semelaigne
would write subsequent historical books—including several biographical anthologies. In England, Daniel
Hack Tuke did a volume of admirable essays on the subject in 1882. However, as with history generally, it
was the German-speaking lands that pioneered in medical/psychiatric history. Physicians were first rigorously
educated in the 13-year Gymnasia: in history, philosophy and its history, literature, and in the ancient
(Greek and Latin) and several modern foreign languages—as well as of course in mathematics and natural
philosophy or science.
In the premedical part of their university curricula they studied some medical history, or pursued intensive
training in it throughout their medical educations—in institutes for the history of medicine such as

Karl Sudhoff ’s in Leipzig. They also pursued hard-nosed medical basic and clinical science training; but
they had the humanistic skills to do first-class archivally-based historical research in the original languages
and sources too. And a fair percentage of students did their M.D. theses in medical history.
Sudhoff was the first great medical historian; and he founded the first serious international journal of the
subject, still subtitled “Sudhoff’s Archive.” He brought rigorous, primary source/archival, scientific/
critical Rankian historical research methodology to medical history (see Chapter 1 for much on Ranke). It
is no accident that he trained the first eminent British historian of medicine, Charles Singer; as well as the
first eminent medical historians to come to America: Henry Sigerist and Oswei Temkin in 1929 (at the
Hopkins Institute for the History of Medicine). Oswei Temkin, who later became Director of the Baltimore
Institute; lived over 100 years, and was probably the greatest twentieth century scholar of the subject (see
“Prolegomenon”). His (1977) The Double Face of Janus and Other Essays in the History of Medicine not
only anthologizes his finest papers, but begins with a substantial history of medical history itself—
including a fascinating social history of the early twentieth century period at the Leipzig Institute. Lloyd
Stevenson, M.D., Ph.D., was Director of the Hopkins Institute when Wallace was there in 1978. Stevenson
had been a doctoral student under Temkin’s direction, in the late-1940s, and spoke highly of a semester-long
series of lectures by Temkin on the history of psychiatry. When Wallace asked Temkin about them, he
replied, “Oh, I threw them away. They weren’t good enough to publish; and others have already done the
work by now.” If only Temkin had been less humble, we would have 400 important manuscript pages on our
subject’s history! They would undoubtedly have been stronger than Zilboorg’s—which latter learned most
of the medical history he knew from Sigerist and Temkin.
Physician historians, by virtue of their scientific and clinical training, focused mainly on “historying”
theoretical, investigative, descriptive/diagnostic, and therapeutic developments and issues within medicine
and its basic sciences themselves. This would become known as “internalist” medical history—as opposed
to history which emphasizes the sociocultural, political-economic, and general intellectual context within
which medical science and practice unfolded. The influx of social and cultural Ph.D. historians into departments
of the history of science and medicine brought an important “externalist” balance to overly “internalist”
history. Indeed, a social historian, Richard Shryock, Ph.D., succeeded Sigerist as Director of the
Hopkins Institute in the 1950s. This externalist twist increased in the late 1960s/early 1970s, and picked up
considerable steam during the 1980s and ‘90s. In fact, for a time externalist approaches tried to narrate and
explain science/medical/psychiatric history without reference to these disciplines’ internal development or
problematics and attempted solutions to them. Fortunately the pendulum has swung toward midpoint; with
an appreciation that any balanced history must address both sets of factors.
Still, there is not only a paucity of up-to-date, English-language general psychiatric histories, but serious
deficiencies in their comprehensiveness, nonpartisanship, assumptive starting points, interpretations,
research rigor and methodology, and even the veridicality of many of their assertions (more later, in
Chapter 1). Regrettably, the paper-bound (1967) edition of Gregory Zilboorg’s (and George Henry’s)
(1941), The History of Medical Psychology (omitting Henry’s competent 1941 chapter on organic
psychiatry—as well as Henry Hurd’s on hospital psychiatry!), is still readily available. It is the text and the
edition most used in psychiatric residencies; as is Franz Alexander and Sheldon Selesnick’s (1966) similarly
problematic and poorly end-noted, though somewhat more comprehensive, The History of Psychiatry
(still in print with Mentor paperbooks).
For example, in a 1962 survey Knoff found Zilboorg’s the standard text in residencies where psychiatric
history was taught at all; and in 1973 Werman found similarly, as did Wallace in a 1990 survey. Since
Alexander and Selesnick’s 1966 publication of their book, it has run a close-second to Zilboorg’s as the
text of choice. Shorter’s 1997 History of Psychiatry (limiting its purview to the modern period) has, regrettably,
been somehow lost in the shuffle.
Otherwise, the two best introductory texts are seldom used at all: Erwin Ackerknecht’s and George
Mora’s. The former’s book, the revised second edition of Short History of Psychiatry (109 pages),
appeared simultaneously in the German-language original and an English-language translation (by Sula
Wolf) in 1968. Ackerknecht was Director of the Institute for the History of Medicine at the University of
Zurich and a world-class scholar of nineteenth century French medicine. He also authored the best short
history of medicine generally in 1982 (revised and expanded edition). Wallace had the pleasure of knowing
Ackerknecht during his 1978 visit to the Hopkins Institute for the History of Medicine. Trained not
only in medicine and its history, but also ethnology, his breadth of knowledge was incredible. He was,
however, a man of strong opinions. For instance, he told Wallace, in no uncertain terms, that Freud was a
“charlatan” and Jung “a scoundrel”! Regrettably, this caused him to overfocus on neurobiological psychiatry,
to the detriment of psychosocial/psychotherapeutic orientations—and to German Romantic psychiatry,
which he summarily dismissed. One of our book’s authors, Otto Marx, studied under him in the latter
1960s. In light of his preceptor’s biases, it is interesting that Marx went on to become one of the world’s
foremost scholars of Romantic medicine and psychiatry.
George Mora (whom we are proud to count among our writers) studied medicine and its history at the
University of Genoa, where he was awarded the M.D. He pursued historical, as well as psychiatric and
child psychiatric training, in Italy, Switzerland, and America. For a time he studied with Gregory Zilboorg,
becoming able to sort the wheat from the chaff. His history of psychiatry comprised the opening chapter
in The Comprehensive Textbook of Psychiatry from its 1967 through its 1980 editions. It is this last,
“Historical and Theoretical Trends in Psychiatry,” about 100 pages (with an excellent bibliography of primary
and secondary sources), which has constituted the best English-language introductory treatment of
psychiatry’s history to date. It also reflects—like all Mora’s work—his extensive mastery of ancient and
modern European languages. See Chapter 1 for more on these and other surveys.
While some good comprehensive histories exist (e.g. Leibbrand and Wettley’s and others), they have
not, regrettably, been English-language translated. However, Yale’s M.D., Ph.D. medical/psychiatric historian,
George Rosen, wrote the seminal Madness in Society in 1968; he subtitled it Essays in the Historical
Sociology of Mental Illness. Mark Micale and Roy Porter edited Discovering the History of Psychiatry in
1994. It comprises excellent historiographical essays by experienced scholars on a variety of topics and
issues. Micale and Porter’s reflective introductory essay is worth the price of the volume. This book is also
a gold-mine of primary and secondary sources in several languages. There is, furthermore, William
Bynum and Roy Porter’s invaluable edited 2-volume Anatomy of Madness (1983–1989). These and other
important books are “referenced” in Chapters 1 and 2. And of course Ellenberger’s monumental 1970
Discovery of the Unconscious: The History of Dynamic Psychiatry is a model for sound psychiatric historical
work. In this context, see Mark Micale’s edited collection of Ellenberger’s unpublished papers,
which includes the editor’s monograph-length biographical, historical, and historiographical essay:
Beyond the Unconscious (1993).
Somewhat earlier noteworthy English-language texts include A. Deutsch’s (1937) The Mentally Ill in
America; J. K. Hall et al.’s. (1944), One Hundred Years of American Psychiatry; W. Bromberg’s (1954), Man
Above Humanity: A History of Psychotherapy; K. Jones’s (1955 and 1960), Lunacy, Law, and Conscience
1744–1845 and Mental Health and Social Policy 1845–1959; D. Leigh’s (1961), The Historical Development
of British Psychiatry; of course R. Hunter and Ida Macalpine’s (1963) magisterial Three Hundred Years of
Psychiatry 1535–1860; and our own N. Tomes’s Thomas Kirkbride: A Generous Confidence.
In short, there is a crying need for an up-to-date and comprehensive introductory English-language text
on the general history of psychiatry and medical psychology. It is this need we hope to have met.
While the book is comprehensive in its coverage of periods and many of psychiatry’s topics and interfaces
as well, the latter are so potentially exhaustive as to require separate volumes in and of themselves.
Unfortunately, a number of quite-competent chapters had to be omitted due to space restraints, on Adler’s
individual psychology; Jung’s analytical psychology; phenomenological and existential psychiatry/
psychology; popular twentieth century psychotherapies; Anglo-American forensic psychiatry; British
hospital psychiatry; child psychiatry; psychiatry and popular culture; psychiatry and religion; feminism
and psychiatry; and medical/psychiatric history and postmodernism.
Moreover, as Erwin Ackerknecht asserted in his short history, little serious work has been done on
“Baroque” (or seventeenth century) psychiatry. Although we do not have a separate chapter on it,
Jackson’s essay on melancholia and depression deals with some of its major physician and lay writers, and
Wallace’s Chapter 26 treats some of its major philosophical psychologists (who are really more important
than the physicians). See also Hunter and Macalpine’s aforementioned Three Hundred Years of Psychiatry
on the “Baroque.” If this book does well, we anticipate a supplementary volume with these and other
essays. Meanwhile, see Howells’s aforementioned book on a number of national psychiatries; and
Ellenberger’s on Adlerian and Jungian psychiatry (as well as on Janet). For phenomenological and existential
psychiatry/psychology see Ellenberger’s and Rollo May’s introductory chapters on them; as well as
the anthology of translations of key texts by figures such as Binswanger and Minkowski: Existence, eds.
Ellenberger, May, and Angel (Basic, 1958).
We have attempted to maintain as much coherence and thematic unity as is achievable with an edited
book. Where indicated, authors have had access to one another’s essays. Ideally, of course, this volume
would have come from a single and quite singular pen. However, far too much detailed archival and monographic
work remains to be done before such could become the case. It is doubtful that any but the tersest
overview (like Ackerknecht’s) could be produced by a single author; and the thematic unity thereby
attained (e.g., Zilboorg, Alexander and Selesnick, and Ackerknecht) could well be as much a factual,
methodological, and interpretative loss as a literary gain. And that one mind could master the pertinent
secondary and tertiary––much less primary––sources, and the countless pertinent interfaces, is nearunbelievable.
What is wanting is a multi-volume “Handbuch”—in the true Germanic sense of the term—
arranged both by periods and special topics; each single-authored by an expert in his or her field: a
psychiatric version of the Cambridge Ancient, Medieval, and Modern History.
Nevertheless, we believe this book fills a gap. Moreover, the history of clinical psychology is treated in
a number of places (see, e.g., Chapters 2, 21, and 22). Nancy Tomes’s essay is totally devoted to the twentieth
century–long rise of clinical psychology, social work, and psychiatric nursing. Because of this, as
well as because many issues pertinent to all the mental health disciplines are treated herein, we hope this
book will prove useful to teachers of their histories as well. Even so, we are not so smug or purblind as to
call it “A Handbook.”
History, like science, is never a finalizing or “definitive” enterprise. It is a never-ending and selfrevising
one in light of novel vantages, methodologies, and data. This is especially true of a field like
psychiatry which, again (historically and presently), overlaps a plethora of human disciplines and
concerns. Indeed, as Simon (Chapter 3) points out, epistemologically the very subject matter of psychiatric
history is disputable. This multifariousness probably explains why psychiatry has attracted, in recent
decades, far more professional historians and social scientists than any other medical specialty.
Our scholars come from a variety of national, professional, and academic historical backgrounds. For
example, although only 3 of our 17 writers are not U.S. residents (i.e., Crabtree is Canadian and Berrios
and Healy are British), a significant percentage of them were born, reared, and educated (at least partly)
elsewhere: George Mora (Italy and Switzerland); Dora Weiner (Germany and France); Herbert Weiner
(Austria and England); Otto Marx (Germany and Switzerland); and Stanley Jackson (Canada). Thus, ours
is hardly as purely an American enterprise as it might seem at first blush. And American scholars, such as
Hannah Decker, are steeped in European general and intellectual history.
Most of our non-M.D. essayists have also had training or experience in one or another of the mental
health disciplines. All are well published in their particular psychiatric historical subspecialties. Their
chapters yield various mixtures of “internalist” and “externalist,” or intellectual and social historical,
purviews (to be elaborated on in Chapter 1). None, however, is insensitive to this dialectic and to the
necessary complementarity of both purviews. Moreover, attention is given to the provocative ideas and
revisionist medical/psychiatric history of Foucault—in several places, including Edwin Wallace’s, George
Mora’s, and Dora Weiner’s chapters.
Clinical psychiatric (and M.D. psychoanalytic) readers will find some of the essays provocative and
controversial: for example, Gilman’s on schizophrenia as concept; Healy’s on psychopharmacology;
Tomes’s on the history of the mental health professions; and Gifford’s on the social (i.e., institutional)
history of American psychoanalysis—especially because of his consistent advocacy for lay analysis. As
editors, we have persistently protected their purviews and arguments, as they are well researched and
reflect—as does all “historying”—various stances on their material. However, we have reserved the
editorial right for commentary and critique, when deemed necessary.
Moreover, any profession needs periodic cage-rattling. In this sense even anti-psychiatric writers such
as Szasz, Laing, Goffman, Foucault, and Scull offer some corrective points of view—despite the extremity
of their overall claims. Many of the possible standpoints on historical issues, when inspected more
deeply, turn out to be complementary rather than contradictory. Others reflect competing positions which
are, however, evidentially decideable. For example, Jackson and Berrios differ on the importance of the
affective or “felt emotional” aspect of major depression—as opposed to its perceptual/cognitive disturbances,
vegetative signs, and diffuse somatic complaints—as medical diagnostic criteria for melancholia
or major depressions, even though both are widely respected scholars of psychiatric nosology. Simon’s
chapter on classical antiquity figures in the controversy as well; for ancient medical descriptions of
“melancholia” hammer home that we would almost certainly consider many of them to be schizophrenic.
But, in deliberating on Berrios and Jackson vis-à-vis one another; we must carefully avoid making it a war
over words. By this I mean that the classical Greek concept of “melancholia” was a broad umbrella indeed:
incorporating descriptions of both major depressives and schizophrenics. The substantive issue is whether,
as Jackson contends, “felt emotional pain” was consistently—throughout Western medical history—a
nosographical desideratum for depression/melancholia; or whether, as Berrios maintains, it only became
prominent in earlier nineteenth century European (especially French) psychiatry.
Each man read the other’s essay (as well as Simon’s). This led Jackson to add a proviso on the complexity
of the issue. Part of the difficulty is that each scholar is concerned with somewhat different material.
Much of Jackson’s focus is on the pre- and proto-psychiatric literature (much of it by laymen)—and
as much with individual depressives’ accounts, as with those of their doctors. Indeed, Berrios is hardly
arguing that no melancholic ever struggled with dysphoric emotion prior to the early nineteenth century!
Instead, his emphasis is on medical diagnostic habits and diagnostic criteria in the modern centuries—
that is, seventeenth through twentieth—with italics on nineteenth century psychiatric practice. In this
light, Berrios is indeed correct that dysphoric affect received increased nosographic attention with the progressive
consolidation of the psychiatric profession throughout the 1800s.
The Introduction: Synopsis and Overview, which immediately follows this Preface, is the reader’s
Baedecker to the book as a whole. As to the book’s format, it is divided into four major sections:
Prolegomenon; Periods (subdivided into “Proto-Psychiatry” and “The Growth of Psychiatry as a Medical
Specialty”); Concepts and Topics (subdivided into “Concepts” and “Topics”); and Epilogue: Psychiatry
and the Mind-Body Relation. Arguably, the mind-body relation is the hottest topic in today’s psychiatry,
given the ongoing warfare among the biopsychosocial, psychological, psychosocial/cultural, and neuropsychiatric
approaches.
In conclusion, this text is intended to serve as: (1) a reference book; (2) an introduction and bibliography
for the novice; (3) a resource for courses and seminars on the history of psychiatry and the mental
health disciplines—whether in universities, graduate schools, or professional training programs; (4) a
collection of well-researched and stimulating essay-length monographs for serious students and scholars;
(5) a demonstration of numerous interpretative and methodological strategies in psychiatric/psychological
history; and (6) good reading for those who are, unabashedly, just plain aficionadoes of medical and
psychiatric/psychological history.