Skip to main content Accessibility help
×
Home
Hostname: page-component-5d6d958fb5-z6b88 Total loading time: 0.56 Render date: 2022-11-28T01:07:26.727Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

Reading about … the history of psychiatry

Published online by Cambridge University Press:  02 January 2018

Allan Beveridge*
Affiliation:
Queen Margaret Hospital, Whitefield Road, Dunfermline KY12 0SU, UK. Email: allanbeveridge@nhs.net
Rights & Permissions[Opens in a new window]

Extract

In recent decades ideological battles have raged over how the history of psychiatry should be interpreted. Should the emergence of psychiatry in the late 18th century be seen as the triumph of the Enlightenment, ushering in a rational approach to mental illness and overturning the primitive and often barbaric ideas of previous eras? Or should the rise of psychiatry be seen in a more sinister light? Does it represent the extension of the state into the lives of its citizens, controlling and policing the disaffected and discontented? Are psychiatrists benign humanitarians or agents of oppression? Should the historical narrative be one of progress, as psychiatry steadily extends its knowledge of mental illness and develops more and more effective therapy? Or is the reverse true: has the advent of psychiatry been a calamity for the mad?

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2012 

In recent decades ideological battles have raged over how the history of psychiatry should be interpreted. Should the emergence of psychiatry in the late 18th century be seen as the triumph of the Enlightenment, ushering in a rational approach to mental illness and overturning the primitive and often barbaric ideas of previous eras? Or should the rise of psychiatry be seen in a more sinister light? Does it represent the extension of the state into the lives of its citizens, controlling and policing the disaffected and discontented? Are psychiatrists benign humanitarians or agents of oppression? Should the historical narrative be one of progress, as psychiatry steadily extends its knowledge of mental illness and develops more and more effective therapy? Or is the reverse true: has the advent of psychiatry been a calamity for the mad?

A multitude of different disciplines: psychiatrists, psychologists, philosophers, sociologists, historians and cultural commentators, have sought to answer these questions, and, not surprisingly, have provided different answers depending on their perspectives. For the novice, this can be bewildering as so many contradictory voices fight to be heard. This, however, is one of the appeals of the subject. The reader has to determine for themselves what they consider to be the most convincing account of the history of psychiatry. This dilemma mirrors the situation in contemporary psychiatry. Although some would like to maintain that there is only one authoritative explanation of mental illness, the biomedical one, there are, in fact, many different and competing approaches, and the individual clinician has to decide which is the most appropriate for any given situation.

The history of psychiatry used to be written, in the main, by clinicians and, not unexpectedly, the tale they told was one of benign progress. These histories came to be viewed by those outside the discipline as self-congratulatory and serving to legitimise psychiatry's role in the present. This rather cosy state of affairs was unsettled by histories of the subject written by those outwith the psychiatric profession. The French philosopher, Michel Foucault's Madness and Civilisation Reference Foucault and Howard1 appeared in English in 1965, and the Edinburgh-born American sociologist, Andrew Scull published Museums of Madness Reference Scull2 in 1979. These key works challenged conventional accounts, stirring debate and inspiring original historical research to test whether these authors’ broad generalisations were confirmed by an examination of primary sources.

The 1980s and 1990s witnessed a great deal of activity in the field of the history of psychiatry. It attracted psychiatrists who studied the case notes of Victorian asylums to discover who was admitted and the nature of their problems. Reference Beveridge3Reference Turner6 Historians were attracted by the new readings of psychiatry's past, and a lively, if at times acrimonious, debate took place at conferences and in learned journals. Some degree of rapprochement between the opposing sides was eventually reached, as demonstrated by the appearance in 1991 of the journal History of Psychiatry, which was originally edited by a psychiatrist, German Berrios, and an historian, Roy Porter.

General histories of psychiatry

A good place to start reading about the history of psychiatry is with general overviews of the subject, though it is as well to be aware that these inevitably reflect the particular outlook of the authors. One of the earliest books on the subject was Chapters in the History of the Insane in the British Isles Reference Tuke7 by Daniel Hack Tuke, a former editor of the Journal of Mental Science (as the British Journal of Psychiatry was known in the 19th century). This book, which was published in 1882, told a story of the steady advancement of psychiatry from its origins at Bethlem, through the founding of the York Retreat, to the championing of the non-restraint policy at Lincoln and Hanwell asylums. Tuke concluded: ‘The old system, in short, believed in harshness and darkness; the creed of the new is, “I believe in sweetness and light’” (p. 495).

The mid-20th century saw the publication of Gregory Zilboorg's A History of Medical Psychology, Reference Zilboorg and Henry8 which also recounted a narrative of progress. However, in this book, it was the advent of psychoanalysis that was portrayed as the triumphant finale to the story. Episodes from the past were examined and judged by the extent to which they anticipated Freudian principles. Somatic approaches were generally decried as leading to a dead end, whereas psychological approaches were treated positively. Several decades later, Edward Shorter told a similar tale of the progress of psychiatry in A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, Reference Shorter9 but this time it was biological approaches that were being celebrated and Freudian ideas that were derided as a fruitless detour from the path of the natural sciences. Fulford & Thornton offered an alternative reading to these linear accounts in their Oxford Textbook of Philosophy and Psychiatry. Reference Fulford, Thornton and Graham10 Here, psychiatry is seen as alternating between psychological and physical approaches to mental illness. The authors suggest that exclusively focusing on only one is misguided and they see the task of present-day psychiatry as attempting to reconcile the two.

In the mid-20th century, the mother-and-son team of Ida Macalpine and Richard Hunter, both psychiatrists, produced many important works on the history of psychiatry. They edited the impressive and weighty Three Hundred Years of Psychiatry 1535–1860, Reference Hunter and Macalpine11 in which they collected the key psychiatric texts of the period and provided a succinct summary of the authors and the significance of their work. They also wrote about the madness of George III, Reference Macalpine and Hunter12 claiming that he suffered from porphyria, though this has recently been challenged by a re-examination of the clinical notes and contemporary letters, which suggest that he actually had a manic–depressive illness. Reference Peters and Beveridge13

A Century of Psychiatry, Reference Freeman14 which appeared at the millennium, was edited by another former editor of the British Journal of Psychiatry, Hugh Freeman, who wrote extensively on the history of psychiatry and did much to encourage research. This multi-authored volume provides a very accessible introduction to a hundred years of psychiatry. Developments in psychiatry are placed in the context of world events, and there are plentiful illustrations and lists of suggested reading. Unsurprisingly, given that the authors are mainly psychiatrists, it presents a fairly positive, and at times uncritical, account of the development of the discipline. Freeman also co-edited with German Berrios two valuable volumes on the history of British psychiatry, 150 Years of British Psychiatry, 1851–1991 Reference Berrios and Freeman15 and 150 Years of British Psychiatry: The Aftermath. Reference Berrios and Freeman16 These are, again, multi-authored books which cover a wide range of subjects. There are biographies of individual psychiatrists, considerations of various institutions and essays on psychotherapy, psychosurgery and the anti-psychiatry movement.

The late Michael Shepherd, former editor of Psychological Medicine, was another psychiatrist who did much to promote historical research. Along with the historians William Bynum and Roy Porter, he edited the three-volume series entitled The Anatomy of Madness. Reference Bynum, Porter and Shepherd17 This contained essays which looked at individual patients, institutions and psychiatric theory. Stand-out chapters include Roy Porter on the melancholy of Samuel Johnson, Trevor Turner on the ‘gloomy genius’ of Henry Maudsley, and Anthony Clare on Freud's case histories.

Histories of madness and treatment

Two of the leading historians in the field have written short histories of madness: Roy Porter (Madness: A Brief History) Reference Porter18 and Andrew Scull (Madness: A Very Short Introduction). Reference Scull19 Significantly, they chose to write about the history of madness, rather than psychiatry, arguing that this allowed them to consider how the wider culture has conceived of mental disturbance over the centuries. Porter typically drew on his extensive reading in the humanities and his interest in individual patients to provide a highly readable account. He devoted a lot of attention to Freud to whom he was generally sympathetic. Scull is much more critical of Freud and, indeed, of psychiatry generally, but nevertheless, provides another very readable history of the subject. Written nearly a decade after Porter's book, Scull brings the story up to the present day and draws on the work of David Healy to express alarm at the influence of the pharmaceutical industry on the practice of psychiatry. Healy himself has been a major commentator on the development of drugs in psychiatry, notably in The Anti-Depressant Era Reference Healy20 and The Creation of Psychopharmacology, Reference Healy21 the latter examining the discovery of antipsychotic medication. Healy's pioneering research on the often unhealthy relationship between the psychiatric profession and the drug companies has shed light on an area that vested interests wished to keep hidden. Healy has also co-written, with Edward Shorter, Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness, Reference Shorter and Healy22 while Elliot Valenstein has provided a history of physical treatments in the first half of the 20th century in Great and Desperate Cures: The Rise of and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. Reference Valenstein23

Various

There is a vast literature on Freud, much of it critical. A good introduction is Henri Ellenberger's classic The Discovery of the Unconscious, Reference Ellenberger24 which, as well as examining the work of the Viennese analyst, looks at the origins of psychodynamic ideas in the context of European culture and considers such figures as Mesmer, Nietzsche, Janet and Jung. Scull and colleagues Reference Scull, Hervey and MacKenzie25 have looked at the lives of 19th-century British alienists, like W. A. F. Browne, John Conolly and Alexander Morison. Their tone is sceptical and they are critical of the ‘Great Man’ theory of history, which sees events being shaped by heroic individuals rather than by wider social forces. Talking about Psychiatry Reference Wilkinson26 gathered together interviews with many of the leading British psychiatrists of the 20th century and provides a valuable oral historical record of the psychiatric profession. The early career of R. D. Laing is examined in Portrait of the Psychiatrist as a Young Man, Reference Beveridge27 a book which attempts to place the radical Scottish psychiatrist in his cultural and clinical context.

The most authoritative book on symptomatology is German Berrios's The History of Mental Symptoms, Reference Berrios28 which draws on the author's extensive research and his command of foreign languages to trace the origins and changing concepts of psychopathology. Berrios has also co-edited with Roy Porter the useful A History of Clinical Psychiatry, Reference Berrios and Porter29 which considers clinical syndromes from the psychiatric and historic point of view, and mania Reference Healy30 and hysteria Reference Scull31 have each been the subject of recent books.

The patient perspective has been considered in A Mad People's History of Madness Reference Peterson32 by Dale Peterson and A Social History of Madness: Stories of the Insane Reference Porter33 by Roy Porter. Porter's The Faber Book of Madness Reference Porter34 also contains extracts from writings of the mentally afflicted, as well as contributions by psychiatrists, novelists and philosophers. Elaine Showalter wrote an early feminist critique of psychiatry in The Female Malady: Women, Madness and English Culture, 1830–1980, Reference Showalter35 but a more balanced account is Lisa Appignansesi's Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present. Reference Appignanesi36

The reader of books on the history of psychiatry will encounter many of the ethical and clinical issues which confront us today. They will see how our predecessors grappled with these problems and discover that many of the ideas which we regard as new were being discussed many years ago.

References

1 Foucault, M. Madness and Civilisation: A History of Insanity in the Age of Reason (trans Howard, R). Tavistock, 1965 (originally published in French in 1961).Google Scholar
2 Scull, A. Museums of Madness: The Social Organisation of Insanity in Nineteenth Century England. Penguin Books, 1979.Google Scholar
3 Beveridge, A. Madness in Victorian Edinburgh: a study of patients admitted to the Royal Edinburgh Asylum under Thomas Clouston, 1874–1908. Part I. Hist Psychiatry 1995; 6, 2154.CrossRefGoogle Scholar
4 Beveridge, A. Madness in Victorian Edinburgh: a study of patients admitted to the Royal Edinburgh Asylum under Thomas Clouston, 1874–1908. Part II. Hist Psychiatry 1995; 6, 133–56.Google Scholar
5 Doody, GA, Beveridge, A, Johnstone, EC. Poor and mad: A study of patients admitted to the Fife and Kinross District Asylum between 1874 and 1899. Psychol Med 1996; 26: 887–97.CrossRefGoogle ScholarPubMed
6 Turner, T. A Diagnostic Analysis of the Casebooks of Ticehurst House Asylum, 1845–1890. Psychological Medicine Monograph Supplement 21. Cambridge University Press, 1992.Google Scholar
7 Tuke, DH. Chapters in the History of the Insane in the British Isles. Kegan Paul, Trench & Co, 1882.Google Scholar
8 Zilboorg, G. A History of Medical Psychology (in collaboration with Henry, GW). WW Norton, 1941.Google Scholar
9 Shorter, E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. John Wiley and Sons, 1997.Google Scholar
10 Fulford, KWM, Thornton, T, Graham, G. Oxford Textbook of Philosophy and Psychiatry. Oxford University Press, 2006.Google Scholar
11 Hunter, R, Macalpine, I. Three Hundred Years of Psychiatry 1535–1860. Oxford University Press, 1963.Google Scholar
12 Macalpine, I, Hunter, R. George III and the Mad Business. Penguin Press, 1969.Google Scholar
13 Peters, T, Beveridge, A. The madness of King George III: a psychiatric re-assessment. Hist Psychiatry 2010; 21: 2037.CrossRefGoogle Scholar
14 Freeman, H (ed). A Century of Psychiatry. Mosby, 2000.Google Scholar
15 Berrios, GE, Freeman, H (eds). 150 Years of British Psychiatry 1841–1991. Gaskell, 1991.Google Scholar
16 Berrios, GE, Freeman, H (eds). 150 Years of British Psychiatry: The Aftermath. Volume II. Athlone, 1996.Google Scholar
17 Bynum, WF, Porter, R, Shepherd, M (eds). The Anatomy of Madness: Essays in the History of Madness. Volumes 1–3. Tavistock Publications, 1985; 1985; 1988.Google Scholar
18 Porter, R. A Short History of Madness. Oxford University Press, 2002.Google Scholar
19 Scull, A. Madness: A Very Short Introduction. Oxford University Press, 2011.CrossRefGoogle Scholar
20 Healy, D. The Antidepressant Era. Harvard University Press, 1997.Google Scholar
21 Healy, D. The Creation of Psychopharmacology. Harvard University Press, 2002.CrossRefGoogle Scholar
22 Shorter, E, Healy, D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press, 2007.Google Scholar
23 Valenstein, E. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. Basic Books, 1986.Google Scholar
24 Ellenberger, FH. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. Basic Books, 1970.Google Scholar
25 Scull, A, Hervey, N, MacKenzie, C. Masters of Bedlam: The Transformation of the Mad-Doctoring Trade. Princeton University Press, 1996.Google Scholar
26 Wilkinson, G. Talking About Psychiatry. Gaskell, 1993.Google Scholar
27 Beveridge, A. Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R. D. Laing, 1927–1960. Oxford University Press, 2011.CrossRefGoogle Scholar
28 Berrios, G. The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge University Press, 1996.CrossRefGoogle Scholar
29 Berrios, G, Porter, R (eds). A History of Clinical Psychiatry. Athlone, 1995.Google Scholar
30 Healy, D. Mania: A Short History of Bipolar Disorder. The Johns Hopkins University Press, 2008.Google Scholar
31 Scull, A. Hysteria: The Biography. Oxford University Press, 2009.Google Scholar
32 Peterson, D. A Mad People's History of Madness. University of Pittsburgh Press, 1982.Google Scholar
33 Porter, R. A Social History of Madness: Stories of the Insane. Weidenfeld & Nicolson, 1987.Google Scholar
34 Porter, R (ed). The Faber Book of Madness. Faber & Faber, 1991.Google Scholar
35 Showalter, E. The Female Malady: Women, Madness and English Culture, 1830–1980. Virago Press, 1987.Google Scholar
36 Appignanesi, L. Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present. Virago, 2008.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
2
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Reading about … the history of psychiatry
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Reading about … the history of psychiatry
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Reading about … the history of psychiatry
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *