Franz Alexander founded the Chicago Psychoanalytic Institute. At the end of his life he wrote a book called The history of Psychiatry[1]. This book is an example of Whig-history. Whig-history looks upon history as a progressive process that leads us away from savagery and ignorance towards peace, prosperity and science[2]. Alexander’s view on the history of psychiatry follows the same line of arguments. He describes for instance that medicine has improved the nature of man’s existence[3]. Others such McKeown disagree on this. McKeown ascribes the impovement in health to non-medical factors such as nutrition and hygiene[4].

But Alexander has a very positive and finalistic view on medicine and especially psychiatry and psychiatrists. Among other things psychiatrists get the most arduous in all medicine[5]. We have come a long way but now “psychiatry has come of age”[6]. All this progress culminates according to Alexander into Freud’s psychoanalytical theory. This advancement was in large part the fruition of thousands of years of study of the human psyche, but it became possible only after Freudian discoveries transformed psychiatry and penetrated general medical thought[7]. Freud’s theory is the most effective and comprehensive expression of this search [for understanding a man's destination and the meaning of his life[8].

Foucault disagrees with Alexander’s view. The history of psychriatry is not for the benefit of mankind. In his book Geschiedenis van de waanzin[9] he searches for the moment when reason and madness where not divided yet[10]. According to Foucault two big events took place in the history of madness: the foundation of the ‘Hopital général’ in 1657 and the release of the chains in 1794[11].

In her book Console and classify[12] Goldstein diggs into moral treatment. In short, moral treatment was the use of the intellect and emotions instead of bleedings and purgings to cure insanity[13]. Pinel was not the creator of this treatment but he did claim that he was the first one to explain the treatment fully. He also placed the treatment on a scientific footing[14]. Goldstein investigates what the contents of the paradigm are, how it was derived and how it was legitimated[15].

In his book A history of Psychiatry[16] Shorter describes the rise, the fall and again the rise of biological psychiatry. It looks like that Shorter makes a more modest claim than Alexander by naming his book A history of psychiatry instead of The history of psychiatry. But just as Alexander he has a rather positivistic and whiggish idea about the development of psychiatry. Where Alexander focusses Freud’s psychoanalysis Shorter points out that biological psychiatry has been a smashing success[17].

Shorter is very negative about psychoanalysis[18]. The connection between the body and the mind on which biological psychiatry is based, is interrupted by psychoanalysis. Shorter also opposes the anti-psychiatric movement when he states that there is such a thing as mental illness[19]. Mental illness rises above gender and class. It is not a social construction, just as parkinson is not socially constructed[20]. Mental disorders really exist as a natural phenomenon[21]. He also opposes the idea that doctors only do things in their own interest[22].

Verwey claims in his book Psychiatry in an anthropological and biomedical context[23] that German psychiatry was born twice in the 19^th century[24]. Verwey investigates the self-conceptions of these two conceptions. He experiences that philosophical viewpoints within self-reflection vary more than what might be expected from reading philosophical literature from that time[25].

In the first chapter Verwey investigates the anthropological psychiatry in Germany during the first half of the 19^th century. He first describes the use of the word anthropology in that period of time. In short anthropological psychiatry is psychiatry that revolves around the philosophical idea of a man as a psychophysical unity[26]. He shows that the controversy between somaticists and phychicist has its root in different anthropological interpretations of the body-soul relationship[27].

Heinroth is an exponent of the psychicism. In his view anthropological research should serve a practical purpose in life. This was the fulfilment of the religious, ethical duty to be a Christian[28]. The difference between man and animal is his consciousness, according to Heinroth[29]. And the crucial point in the conception of psychic health is freedom[30]. Every psychic disorder is a ‘diseased state’ but not necessarily a disease, because in the case of a disease there must be a process of disease and signs of living reaction[31]. Psychic disorders are generated in the soul and the physical organs are only indirectly affected[32]. The existence of disease or psychic disorder presupposes a fundamental lack of freedom for man, and since, in the final analysis, man is responsible for his own lack of freedom, he is essentially at least partly responsible for the existence of his own diseases and psychic disorders[33]. The somaticist theory is based on the following fundamental principles. All psychic diseases are the result of somatic dysfunctions. The soul only appears to be disordered in the expression of its various functions because the somatic, to which its activity is bound has become diseased[34]. The main difference, Verwey argues, between the somaticists and psychicists was not a conflict between scientific and non-scientific method[35]. It was a conflict of fundamental anthropological conceptions[36].

Engstrom describes in his book Clinical psychiatry in imperial Germany[37] the shift from clinical research done in the asylum to research done in the university. Engstrom describes two kinds of researchers: the alienist researchers and the university researchers. Alienists, such as Laehr, Damerow and Solbrig thought that correct and ample clinical observation was only given in asylums[38]. The university researchers, for instance Griesinger, thought that alienist were too much exposed to the chronic stages of illness. It was not possible for alienists to track the start of the illness. The overcrowding and restraining in asylums distorted the natural expression of the patients’ symptoms[39].

Ruud Abma describes in Madness and mental health[40] the enormous growth of the mental health domain[41]. The domain has expanded both qualitatively as quantatively. Abma states that this expansion is related to cultural and social issues in a rather complicate way. Also developments within psychiatry and psychology played a role[42]. In the 19^th century asylums were transformed into therapeutic institutions. On the theoretical level psychiatrist started with an optimistic view. With the use of scientific rational explanation from the explanation of insanity it should be possible to find the real causes of mental illness[43]. At the end of the 19^th century this optimism was vanished[44]. Kraepelin’s diagnostic system was more descriptive that explanatory[45]. Therefore, psychiatrist turned to nervous disorders.

At the end of the 19^th and the beginning of the 20^th century two things attributed to the growth of the mental health domain. First, psychiatrist went out of the asylums and started treating the nervous disorders. And second, psychological treatment was developed[46]. After the First World War, the concept mental health became a leading concept. The term had a positive vibe. It included the idea that all kinds of (psychiatric) disorders could be cured or managed by scientifically supported therapeutic interventions[47].

In the era between 1930 and 1960 the line between professional and popular psychology became increasingly blurred[48]. The field of mental illness was changing. On the one hand was field of mental illness was broadened. But on the other hand, psychiatrists were trying to heal psychiatric patients with physical treatment, such as ECT and lobotomy[49]. `

The period between 1960 and 1980 was a turmoil for the mental health field as well as society[50]. On the one hand humanistic brands of psychotherapy blossomed whereas psychiatry had to deal with the antipsychiatric movement[51].

The era after 1980 is characterized by rationalism. Therapy for the normal[52] became normal. Also the increasing complexity of mental health organizations caused the introduction of managers[53]. New interdisciplinary sciences, like psychoimmunology, came about[54]. Drug therapy was not the only new development in treatment. Behaviour therapy was also introduced[55]. Abma concludes that the expansion of mental health not only reflects scientification and objectivation of psychiatry, but also reflects the increased strains and problems of modern western society[56].

Porter[57] describes the nervous disorders in 18^th century England and 19^th century developments in general. He shows that already in the 17^th Thomas Willis was studying the nervous system[58]. In 1730s Cheyne saw nervousness as the key to modern malaises. Cheyne saw a country with a decline in health, whereas England became richer and richer. He dubbed this the ‘English Malady’[59]. Only people in the higher level of society could suffer from this malady. During the 19^th century various theoretical models were used to explain nervous problems. Until mid-century spinal irritation was the cause of nervous breakdown. Later a lack of nerve force would become the explanation for malfunctionings of the nervous system[60]. The second law of thermodynamics would also be used as a theoretical model. The energy of the human body was not inexhaustible[61].

In 1869 Beard came up with the construction neurasthenia. His construction was based on the idea that disease was divisible into two categories, an excess of energy and the impossibility to react to a stimulus. Neurasthenia was a disorder of modernity. One of the causes of the ‘sapping of nervous energy’ was the erosion of religious faith[62]. The English malady and neurasthenia share many similarities, but there is also an important difference. Whereas the English malady was the product of affluence, politeness and excess, neurasthenia was the product of living in the fast lane[63].

Shamdasani[64] describes psychastenia introduced by Janet. Psychasthenia consisted of ‘simple’ neurasthenia, depression, phobias and obsessions[65]. Physical symptoms were now the sequelae of a psychological state[66]. The treatment of psychasthenia was a moral treatment. If the patient would have someone to trust and obey, the problems would cease. Priests had done this before, but now doctors could perform this duty as well[67]. Eventually the disease neurasthenia would die. According to Shamdasani this death was caused by the fact that this diagnosis was not linked to an institution that trained patients and patient-practitioners to replicate it[68].

De Swaan[69] wants to show that:

1) The psychoanalytical setting was (just) the continuing of practices taking place in medical practice in general

2) The psychoanalytical setting was a cleaned practice. All interaction was eliminated so that no alternative explanations were possible. This is similar to the processes in scientific research.

3) The psychoanalytic setting was a social-null-situation. (comparable with null-hypothesis in scientific research)

4) The ground rules of psychoanalysis: free association and abstinence introduced a new kind of interaction in the physician’s consulting-room

Reputation was based on technical skill instead of moral qualities. Reputation was important to earn a living. Earning a living was possible by 1) accepting patients from older physicians (or even accepting money from them) or 2) making a big discovery[70].

De Swaan shows that Freud treated his patients mostly in their own surroundings[71]. But consulting patients in a physician’s consulting room was a sign of professional reputation[72].

Freud eliminates all interaction for two reasons:

1. Most of the treatments did not work (f.i. pressure therapy)

2. Because it did not fit within the paradigm. The paradigm: the patient was not to be influenced, since all things the patient did or said was understandable within their own psychological conflicts[73].

The social null situation (Freud’s biggest sociological achievement according to de Swaan) is derived from the null-hypothesis in scientific research. All relevant parameters are fixed except the independent variable. The social-null situation was achieved (or at least approached), since

1. Freud wanted to be a paid a fixed amount at specified times[74]

2. Freud was very strict about times a patient consulted him

3. Patients came to Freud’s consulting room

4. Freud restricted the interaction between physician and patient. A physician is not allowed to fulfil patient’s desires[75].

Literature

R. Abma (2004), ‘Madness and mental health’ In J. Jansz & P. van Drunen, A Social History of Psychology, 93-128.

F.G. Alexander and S. Selesnick, The history of Psychiatry (New York 1966) Chapter 1 & Chapter 8 ‘The Enlightenment’, 3-6; 105-123.

E.J. Engstrom, Clinical psychiatry in imperial Germany. A history of psychiatric practice (Ithaca 2003) Chapter 5: ‘Bedside science: clinical research in Heidelberg’, 121-146.

M. Foucault, Geschiedenis van de waanzin (Meppel 1975) Chapters VIII en IX, 219-272.

J. Goldstein, Console and classify; The French psychiatric profession in the nineteenth century (Cambridge 1990) Chapter 3: ‘The transformation of charlatanism, or the moral treatment’, 64-119

T. Lutz (), ‘Neurasthenia and Fatigue syndromes, social section’ In G. Berrios & R. Porter, A history of clinical psychiatry, 533-544

R. Porter (2001), ‘Nervousness, eighteenth- and nineteenth-century style: From luxury to labour’ in M. Gijswijt-Hofstra & R. Porter eds., Cultures of neurasthenia, 31-49.

S. Shamdasani (2001), ‘Claire, Lise, Jean, Nadia, and Gisèle: Preliminary notes towards a characterisation of Pierre Janet’s psychasthenia’ in M. Gijswijt-Hofstra & R. Porter eds., Cultures of Neurasthenia, 363-385

E. Shorter, A history of psychiatry. From the era of the asylum to the age of prozac (New York 1997) Introduction and chapter 3: ‘The first biological psychiatry’, vii-x; 69-112

A. de Swaan (1977), Over de sociogenese van de psychoanalytische setting’ in A. de Swaan (1983), De mens is de mens een zorg. Opstellen 1971-1981, 51-80

G. Verwey, Psychiatry in an anthropological and biomedical context (Dordrecht 1985), Introduction & Chapter 1: ‘Anthropological psychiatry’, xv-xix, 1-36

S. Wessely (), ‘Neurasthenia and Fatigue syndromes, clinical section’ In G. Berrios & R. Porter, A history of clinical psychiatry, 509-532

---

[1] Alexander, The history of psychiatry
[2] http://ajp.psychiatryonline.org/cgi/content/full/159/8/1305, 1-1-2008[3] Alexander, The history of psychiatry, 3[4] McKeown. The role of medicine, 119

[5] Alexander, The history of psychiatry, 6

[6] Alexander, The history of psychiatry, 4

[7] Alexander, The history of psychiatry, 5

[8] Alexander, The history of psychiatry, 5

[9] Foucault, Geschiedenis van de waanzin

[10] Foucault, Geschiedenis van de waanzin, 7

[11] Foucault, Geschiedenis van de waanzin, 11

[12] Goldstein, Console and classify

[13] Goldstein, Console and classify

[14] Goldstein, Console and classify, 66

[15] Goldstein, Console and classify, 67

[16] Shorter, A history of psychiatry

[17] Shorter, A history of psychiatry, preface

[18] Shorter, A history of psychiatry, preface

[19] Shorter, A history of psychiatry, preface

[20] Shorter, A history of psychiatry, preface

[21] Shorter, A history of psychiatry, preface

[22] Shorter, A history of psychiatry, preface

[23] Verwey, Psychiatry in an anthropological and biomedical context

[24] Verwey, Psychiatry in an anthropological and biomedical context, xv

[25] Verwey, Psychiatry in an anthropological and biomedical context, xviii

[26] Verwey, Psychiatry in an anthropological and biomedical context, 1

[27] Verwey, Psychiatry in an anthropological and biomedical context, 8

[28] Verwey, Psychiatry in an anthropological and biomedical context, 9

[29] Verwey, Psychiatry in an anthropological and biomedical context, 14

[30] Verwey, Psychiatry in an anthropological and biomedical context, 15

[31] Verwey, Psychiatry in an anthropological and biomedical context, 16

[32] Verwey, Psychiatry in an anthropological and biomedical context, 17

[33] Verwey, Psychiatry in an anthropological and biomedical context, 19

[34] Verwey, Psychiatry in an anthropological and biomedical context, 22

[35] Verwey, Psychiatry in an anthropological and biomedical context, 23

[36] Verwey, Psychiatry in an anthropological and biomedical context, 24

[37] Engstrom, Clinical psychiatry in imperial Germany

[38] Engstrom, Clinical psychiatry in imperial Germany, 122

[39] Engstrom, Clinical psychiatry in imperial Germany, 122

[40] Abma, Madness and mental health

[41] Abma, Madness and mental health, 93

[42] Abma, Madness and mental health, 93

[43] Abma, Madness and mental health, 99

[44] Abma, Madness and mental health, 99

[45] Abma, Madness and mental health, 99

[46] Abma, Madness and mental health, 105

[47] Abma, Madness and mental health, 110

[48] Abma, Madness and mental health, 117

[49] Abma, Madness and mental health, 117

[50] Abma, Madness and mental health, 117

[51] Abma, Madness and mental health, 122

[52] Abma, Madness and mental health, 122

[53] Abma, Madness and mental health, 122

[54] Abma, Madness and mental health, 123

[55] Abma, Madness and mental health, 123

[56] Abma, Madness and mental health, 126

[57] Porter, Nervousness, eighteenth- and nineteenth-century style

[58] Porter, Nervousness, eighteenth- and nineteenth-century style, 31

[59] Porter, Nervousness, eighteenth- and nineteenth-century style, 32

[60] Porter, Nervousness, eighteenth- and nineteenth-century style, 37

[61] Porter, Nervousness, eighteenth- and nineteenth-century style, 38

[62] Porter, Nervousness, eighteenth- and nineteenth-century style, 39

[63] Porter, Nervousness, eighteenth- and nineteenth-century style, 42

[64] Shamdasani, Claire, Lise, Jean, Nadia, and Gisèle

[65] Porter, Nervousness, eighteenth- and nineteenth-century style, 366

[66] Porter, Nervousness, eighteenth- and nineteenth-century style, 373

[67] Porter, Nervousness, eighteenth- and nineteenth-century style, 373

[68] Porter, Nervousness, eighteenth- and nineteenth-century style, 379

[69] De Swaan, Over de sociogenese van de psychoanalytische setting

[70] De Swaan, Over de sociogenese van de psychoanalytische setting, 67

[71] De Swaan, Over de sociogenese van de psychoanalytische setting, 55

[72] De Swaan, Over de sociogenese van de psychoanalytische setting, 59

[73] De Swaan, Over de sociogenese van de psychoanalytische setting, 60

[74] De Swaan, Over de sociogenese van de psychoanalytische setting, 70

[75] De Swaan, Over de sociogenese van de psychoanalytische setting, 77

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