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Discourses, Therapies and Conflict: How to Heal the Mind in the 20th Century

Patient Records, Justine Desmond

This week finds us firmly in the 20th century, exploring new discourses of psychiatry, based partly on the emergence of laboratory medicine, and new treatment regimes, several of which involved major interventions compared with regimes of moral management with relatively limited medical activity in the 19th century. We look in particular at the rise of ECT and psychosurgery, and ask questions about the ethics of treatment during this period: were these approaches adopted by psychiatrists who believed there were strong possibilities for curing their patients, were they experimenting on their patients, acting out of desperation, or seeking ways to manage patients' behaviour? And were the drug regimes that came to replace these harsh somatic interventions as bad – giving rise to a new psychiatric straitjacket and a life time of medication? We will contrast these approaches with the psychoanalytic turn, which emerged in the late 19th century and was strongly associated with Freud's work and impact. The articles of Micale and Busfield are good introductions to 20th-century psychiatry. Also useful is the Jones and Rahman article on the Maudsley, which suggests a contrast in terms of approaches to mental illness, and offers a less bleak interpretation of the role of a mental hospital during this period. Joel Braslow’s study, Mental Ills and Bodily Cures bores down into some of these questions in terms of one US institution, and his article 'The Influence of a Biological Therapy on Physicians' Narratives and Interrogations' is fabulous. We will centre this week's seminar around a debate on shock treatment and psychosurgery, further details to follow!

Jonathan Miller's film, in the BBC series 'Madness' (episode ‘Brainwaves), BBC MCMXCI is essential viewing for this seminar, on (feel free to watch the other episodes, available on YouTube, in what is in my view an unsurpassed series on mental illness and its history) Available via Talis Aspire

  1. What impact did ‘biological psychiatry’ have at the turn of the 20th century?

  2. Why did very different dialogues concerning mental illness emerge in the 20th century?

  3. Why were shock therapies and psychosurgery embraced so enthusiastically by psychiatrists in the first half of the 20th century?

  4. ‘The physician’s maxim to “do no harm” never clashes more with the desperate need to “do something” than in the case of psychosurgery’. Discuss.


** Shorter, A History of Psychiatry, ch. 6. e-book 

** Andrew Scull, Madness in Civilization (London: Thames & Hudson, 2015), chs. 10 and 11. e-book

** Mark Micale, ‘The Psychiatric Body’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century(Harwood International, 2000), pp. 323-46. Available via Talis Aspire 

**Joan Busfield, ‘Mental Illness’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century(Harwood International, 2000), pp. 633-51. Available via Talis Aspire

** Edgar Jones and Shahina Rahman, ‘Framing Mental Illness, 1923-1939: The Maudsley Hospital and its Patients’, Social History of Medicine, 21 (2008), 107-25. e-journal

** Faber Book of Madness, ch. 12 ‘Treatments’, pp. 279-349.

* Hugh Freeman (ed.), A Century of Psychiatry(London: Mosby, 1999).

* Hugh Freeman, 'Psychiatry in Britain, c.1900', History of Psychiatry, 21 (2010), 312-24. e-journal 

* Essays in Edwin R. Wallace and John Gach, History of Psychiatry and Medical Psychology (New York: Spinger, 2008). e-book



** Joel T. Braslow, 'The Influence of a Biological Therapy on Physicians’ Narratives and Interrogations: The Case of General Paralysis of the Insane and Malaria Fever Therapy, 1910-1950, Bulletin of History of Medicine, 70 (1996), 577-608. e-journal 

** Joel Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century(University of California Press, 1997). e-book

 ** Mical Raz, ‘Between the Ego and the Icepick: Psychosurgery, Psychoanalysis, and Psychiatric Discourse’, Bulletin of the History of Medicine, 82 (2008), 387-420. e-journal

 ** Jack Pressman, Last Resort: Psychosurgery and the Limits of Medicine(Cambridge University Press, 1998).

 * Eric J. Engstrom, Clinical Psychiatry in Imperial Germany. A History of Psychiatric Practice (Cornell University Press, 2003). e-book

 * Edward M. Brown, 'Why Wagner-Jauregg won the Nobel Prize for Discovering Malaria Therapy for General Paresis of the Insane', History of Psychiatry,11 (2000), 371-82. e-journal

 Deborah Blythe Doroshow, 'Performing a Cure for Schizophrenia: Insulin Coma Therapy on the Wards', Journal of the History of Medicine and Allied Sciences, 62 (2006), 213-43. e-journal

 G.E. Berrios, ‘The Scientific Origins of Electroconvulsive Therapy: A Conceptual History’, History of Psychiatry, 8 (1997), 105-19. e-journal

 G.E. Berrios, ‘Psychosurgery in Britain and Elsewhere: A Conceptual History’, in 150 Years of British Psychiatry.

 G.E. Berrios, ‘Early Electroconvulsive Therapy in Britain, France and Germany: A Conceptual History’, in 150 Years of British Psychiatry II, pp. 3-15.

M. Fears, ‘Therapeutic Optimism and the Treatment of the Insane’, in R. Dingwall (ed.), Health Care and Health Knowledge(London: Croom Helm, 1977), pp. 66-81.

 Andrew Scull, Madhouse: A Tragic Tale of Megalomania and Modern Medicine(Yale University Press, 2005).

* Sander L. Gilman, 'Electrotherapy and Mental Illness: Then and Now', History of Psychiatry, 19 (2008), 339-57. e-journal

* Andrew Scull, 'Somatic Treatments and the Historiography of Psychiatry', History of Psychiatry, 5 (1994), 1-12. e-journal

 * Volker Roelcke, Paul J. Weindling, and Louise Westwood(eds), International Relations in Psychiatry: Britain, Germany, and the United States to World War II (University of Rochester Press, 2010). e-book



** Faber Book of Madness, chs 15 ‘Freud’ and 16 ‘Psychoanalysis’.

 ** Roy Porter, A Social History of Madness: Stories of the Insane(London: Weidenfeld and Nicolson, 1987), chs 5 and 8. Multiple copies in library

 * Frank J. Sulloway, Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend(New York: Basic Books, 1979). e-book

 * Dean Rapp, ‘The Early Discovery of Freud by the British General Public, 1912- 1919’, Social History of Medicine, 3 (1990), 217-43. e-journal

 * Sander L. Gilman, Disease and Representation: Images of Illness from Madness to AIDS (Cornell University Press, 1998), ch. 11 ‘Constructing the Image of the Appropriate Therapist: The Struggle of Psychiatry with Psychoanalysis’, pp. 182-201. e-book and several copies in library

 Shorter,A History of Psychiatry, chs 5, 7 and 8. e-book

 * Peter Gay, Freud: A Life for our Time(London: Papermac, 1989).

 * Peter Gay, Freud for Historians(Oxford University Press, 1985). e-book

 * Peter Gay (ed.), The Freud Reader(London: Vintage, 1995).

 H.J. Eysenck, Decline and Fall of the Freudian Empire(London: Penguin, 1986). e-book

Grubrich-Simitis, Early Freud and Late Freud(London: Routledge, 1997). e-book

Sarah Winter, Freud and the Institution of Psychoanalytic Knowledge: Cultural Memory in the Present (Stanford, CA: Stanford University Press, 1999).