Heiner Fangerau, Karen Nolte. "Moderne" Anstaltspsychiatrie im 19 und 20 Jahrhundert: Legitimation und Kritik. Stuttgart: Franz Steiner Verlag, 2006. 416 pp. EUR 62.00 (paper), ISBN 978-3-515-08805-3.
Reviewed by Eric J. Engstrom (Institut für Geschichtswissenschaften, Humboldt Universität)
Published on H-German (February, 2008)
On the History of Psychiatriekritik and the Silences in Psychiatriekritik as History
This collection of nineteen articles is drawn from a conference held in Göttingen in 2004. Several chapters present new research; others draw heavily on material published elsewhere. The editors see the volume as a contribution to the history of "Psychiatriekritik," or, to be more precise, to the history of the dynamic relationship between the "Legitimationsstrategien der Psychiater" and the "gesellschaftliche sowie innerdisziplinäre Kritik an den grossen Reformideen der Psychiatrie des 19. und 20. Jahrhunderts" (pp. 7-8). Their aims are aptly reflected in a quotation they include from Marburg psychiatrist Franz Tuczek that emphasizes the importance of public trust and confidence for psychiatric asylums. However, moments in history in which asylums have enjoyed widespread public trust are rare. In fact, a marked lack of trust has tended to be the norm. Of course, the reasons for this state of affairs are complicated and in some respects the contributions to this volume can be read as expressions of that fraught relationship. Nevertheless, Nolte and Fangerau are right in drawing our attention to this relationship and insisting that, in studying it, we be attuned to its great subtleties. The material included provides a variety of perspectives on these problems without, however, completely fulfilling the volume's promise.
The early nineteenth century is covered in three solid articles on psychiatric travel reports about asylums in Hesse (Christina Vanja) and the differentiation of institutional care in Düsseldorf (Fritz Dross) and southern Germany (Alexandra Chmielewski). The post-1945 era is likewise covered by three articles: Thorsten Noack's fascinating account of the reception of the Hollywood film The Snakepit (1947) and the public scandal involving neuropathologist Martin-Heinrich Corten, accused of having committed his wife to an asylum in order to be with his lover; Cornelia Brink's strong contribution on the attitudes of asylum psychiatrists, psychiatric critics, and social psychiatrists toward the West German public in the 1960s and 1970s; and Torger Möller's study locating the origins of social prejudices toward epileptics in psychiatric attempts to educate the public. Most of the articles, however, deal with the years 1895-1945. Many of these are clustered around the Irrenrechtsreformbewegung of the late 1890s and therapeutic and public relations responses to it. Topics include the so-called Hägi scandal at the Burghölzli asylum and administrative structures developed to manage patient complaints there (Marietta Meier); narratives and critiques of psychiatry in German literature (Heinz-Peter Schmiedbach); Gustav Kolb's efforts to reform psychiatric care in the 1920s (Astrid Ley); the "bildmediale Legitimationsstrategie" (p. 306) psychiatrists deployed in depicting the new forms of work-therapy in Switzerland (Urs German); and the Volksnervenheilstättenbewegung and psychiatric responses to patient complaints at the sanatorium in Rasemühle near Göttingen (Heiner Fangerau). For the most part these accounts find psychiatrists responding to public criticism either reluctantly or in self-serving ways. Two chapters are also devoted more narrowly to forensic themes, including a study on debates about facilities for psychiatric criminals (Christian Müller) and a patient-centered exploration of the tension between Eigensinn and Irrsinn in cases of Querulantenwahnsinn (Claudia Nolte). Finally, two chapters are devoted to the T-4 killings, one assessing the purported crisis of professional legitimacy that followed the killings (Peter Sander) and another on the conduct and motives of the relatives of T-4 victims, based on letters they wrote to state officials (Petra Lutz). Some of articles seem misplaced in this volume: Brigitta Bernet's fine contribution on Eugen Bleuler's concept of association has at best only tenuous links with the volume's main theme, as does Emese Lafferton's analysis of the social composition of Hungarian psychiatric populations, which is essentially a critique of Elaine Showalter's purported claim that madness was a "female malady." More generally--and as is commonplace in such heterogeneous collections--readers face a challenge aligning some of the papers onto the volume's larger theme.
Despite the heterogeneity of the contributions, it is worth considering the editors' aims and aspirations. In the introduction, they stress a desire to move beyond the narrower historiographical literature on professionalization, institutionalization, and therapeutic concepts. Instead, they are interested in locating the "interdependence" (p. 8) that characterizes the relationship between mental hospitals, psychiatric science and the public sphere. They see themselves working in or alongside several historiographical traditions, including a "'neue' kritische Psychiatriegeschichte" (p. 8) they associate with the work of Michel Foucault, Thomas Szasz, Klaus Dörner and Dirk Blasius; studies on the murderous policies of the Nazi regime and psychiatry's role in implementing them; and Alltagsgeschichte and histories from below, especially from the psychiatric patients' perspectives. The book's title hints at how they position themselves historiographically. The quotation marks around the term 'modern' reflect their somewhat bashful, not yet postmodern distancing from traditional historiographical agendas. They stress that the scare quotes are intended to emphasize the "ambiguity" of the term; and in their exploration of such classically modern themes as "legitimacy" and "critique" they exploit the conveniences of that ambiguity. However, in two respects the editors have fallen short of their aspirations.
First, they have framed the relationship between psychiatry and the public sphere to exclude the voice of psychiatrists as public critics. This omission is especially glaring if we consider the second half of the nineteenth century. Surprisingly, this "heroic" era of asylum psychiatry in Germany is all but absent in the volume. This yawning gap is especially perplexing because the enormous campaign to construct asylums throughout Germany at this time had to be justified and defended in all kinds of ways. Hence, this period would seem to offer fertile ground for an analysis of "legitimation and critique" in relation to asylum psychiatry. In this context, the perplexing question is: how and why were psychiatrists successful in having patients committed to new institutions? Of course, in this case, psychiatrists were the critics and other groups (families, state officials, churches, courts, prison wardens) were on the hot seat. Nevertheless, we need this perspective in any more comprehensive historical analysis of the relationship between psychiatry and the public sphere. In this collection of articles, however, it has been structurally sidelined by the stark juxtaposition of "the psychiatrists" on the one hand, and "öffentliche Psychiatriekritik" on the other. In this dichotomy, the (sometimes substantial) voice of psychiatrists as public critics is silenced. A stronger approach to the history of Psychiatriekritik would have conceptualized the discursive practices of psychiatrists not only in terms of reactive disciplinary legitimation, but also in terms of proactive public critique. Doing so might not have generated the stories anticipated by the editors, but is necessary in order to study the "interdependencies" and map out the complex topography of public discourse on psychiatry.
Second and perhaps more incisively, however, we must ask whether the analytic categories of Kritik and Legitimation can be usefully deployed across such a chronologically broad field of inquiry. Clearly, these categories have entirely different meanings and implications when applied to events in the Kaiserreich, Nazi Germany, the GDR, or the FRG. But the editors have not demonstrated how we might go about using these terms meaningfully in such radically different political contexts. Indeed, they never really reflect at all on these differences and their potentially crippling implications for the analytic utility of the categories themselves. Several of the contributors in the volume recognize this problem. For example, Petra Lutz insists that the question of critique and legitimation is "neither here nor there [läuft ins Leere]" (p. 162) when it comes to assessing the relationship between psychiatry and the T-4 patients' relatives. Arguably, if the volume had included a paper on asylum psychiatry in the GDR, a similar conclusion might have been drawn. By contrast, older historiographical approaches that stress institutions, professionalization, or therapies would seem to be analytically far more resilient when crossing the boundaries of Germany's many nineteenth- and twentieth-century political systems. This is not to argue that we can be satisfied with those rather more prosaic approaches, but it is to insist on the need to cultivate a far more robust interpretation of the relationship between asylum psychiatry and the public sphere than the editors provide in their introduction.
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Eric J. Engstrom. Review of Fangerau, Heiner; Nolte, Karen, "Moderne" Anstaltspsychiatrie im 19 und 20 Jahrhundert: Legitimation und Kritik.
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