Medizin, Gesellschaft, und Geschichte : Jahrbuch des Instituts fur Geschichte der Medizin der Robert Bosch Stiftung最新文献

Based on the wider thesis of the "grand renfermement", psychiatric asylums as well as hospitals (and prisons) should have developed to "total institutions" from late 18th century onwards by gaining public space and further resources devoted to the healing of the (mental) ill who had to be isolated from the healthy citizen following criteria of the modernising medicine. But vis-a-vis to the enormous problems of the early general hospitals to separate the curable based on strictly medical criteria one is astonished, why modern medicine developed two types of institutions and thus doubling its claims on public resources. The article aims to take a look at an early 19th century psychiatric asylum in the town of Dusseldorf from the perspective of the general hospital. That way it tries to get into account the difficult allocation of ill people to one or another hospital. As both had to prove their ability to effectively cure their patients they had to be quite aware whom to let in--and whom to refuse. As they were financed, organised and administrated on different political levels and thus dependent to different governmental bodies (town vs. region) a couple of conflicts become visible which had to be solved in order to establish institutionalisation. Finally, in the long run both had to gain public recognition and acceptance, which only could mean the acceptance of potential patients. The perspective opened by the theorem of the "total institution" seems not to be all-to helpful to that purpose, as it tends to neglect institutional competition as well as the process of gaining the potential patients' acceptance. A more useful perspective could be a comparative analysis based on local examples, which could open the view to the competing establishment of prisons, psychiatric asylums and general hospitals as "useful" types of organizations in a modernising society.

Around 1900 the Swiss psychiatrist Eugen Bleuler developed a new interpretative model of mental illnesses: schizophrenia. He named the breaking of associative threads of thought as the core symptom of the disorder. Shortly after the publication of his "Dementia Praecox or the Groups of Schizophrenias" in 1911, the concept quickly gained popularity outside the discipline of psychiatry. His contempories noticed early on the peculiar relationship that existed between the crisis diagnosed as schizophrenia and the broader societal "crisis of modernity" around 1900. The author shows in what ways this seeming relationship between the interpretation of the disorder and society was already preconfigured in Eugen Bleuler's early writings by reconstructing and contextualising his theory of schizophrenia as developed in the years from 1890 to 1910.

The German psychiatric concept "Querulantenwahnsinn" expresses the link between the juridical discourse, the critiques and the legitimation of asylum psychiatry around 1900. The paper will at first analyse the discourse on "Querulantenwahnsinn". In a second step the "patient's view" (Porter) on that social and psychiatric phenomenon will be constructed on the basis of medical records of the Landesheilanstalt Marburg (asylum). The inquiry of patient's experience demands a reflection of the fact that the clinical picture of "Querulantenwahnsinn" was very plausible. It had been created by psychiatrists as a reaction to the critiques on asylum psychiatry. Every attempt to question the pathologisation of a critical position on asylum psychiatry, every resistance results in a consolidation of the psychiatric diagnosis. Consequently the pathologisation, the confinement into an asylum influenced the auto-perception of the patients--so they possibly enroled in the discourse on "Querulantenwahnsinn" against their explicit will. The paper points out that the discourse on "Querulantenwahnsinn" is an expression of social conflicts and the legal culture in the Wilhelmine society.

The subject of this article is the relation between psychiatric knowledge and social prejudice. This will be observed from the perspective of the medical discourse and the perspective of the history of science in a case study on epilepsy. In context of an increasing democratization of science and society a discussion on the social discrimination of epileptic patients entered the medical discourse in the 1960s and 70s. In the medical discourse the cause for discrimination is ascribed to emotionally determined prejudices found in the population, that are to be countered by educating the population with scientific knowledge. From the perspective of the history of science it however becomes apparent, that the prejudices found in the population are a result of a popularization of psychiatric knowledge beginning in the end of the 19th and reaching well into the 20th century. Thus, it is science and not the population that is the source of these so called prejudices. In the closing remarks these findings are discussed as different 'discourse' strategies for the legitimation of psychiatry and psychiatric objects.

In the 1930s Swiss psychiatrists were engaged in a singular public campaign to promote a new image of their profession. The result of this campaign was a series of booklets about psychiatric institutions. These asylum-monographs, as they were called, encompassed a large number of photographic illustrations, most of which showed patients at work. Taking the visual omnipresence of patients' work in the asylum-monographs as a starting point, this contribution examines the status of occupational therapy in psychiatric discourse and practice in Switzerland at the beginning of the 1930s. The first part of the contribution describes and outlines the development of patients' work in several psychiatric institutions after World War I. Then it turns to the discussion about the introduction of a new and more active form of occupational therapy ("aktivere Therapie") in this period. The second part of the contribution analyzes the meanings of therapeutic work in psychiatric discourse. It shows that the enthusiasm occupational therapy produced among Swiss psychiatrists was mainly due to its ability to change the visual appearance of the asylums. Furthermore it points to several traits of Eugen Bleuler's concept of schizophrenia, especially the assumption of different ranks of primary and secondary symptoms and the notion of autism, which were both crucial to the contemporary understanding and handling of occupational therapy. Finally, it argues that a medical interpretation of patients' work, which identified therapy with working discipline, was a necessary precondition for the omnipresence of patients' work in Swiss psychiatry's public campaign in the 1930s.

The "Hohen Hospitäler", hospitals founded by landgrave Philipp dem Grossmütigen during the years 1533-1542, were seen as an expression of greatest caritas in Early Modern times. These protestant institutions for the poor and sick underlings of Hesse were appreciated as charitable shelters by noblemen and commoners. This situation changed dramatically at the end of the 18th century. The first critics were travelling philosophers of the Enlightenment, who visited the "mad houses" of Hesse as well as other oddities. They published their experiences in travel reports. Although the hospitals as integrated institutions still cared for both psychiatric and somatic patients, these authors only concentrated on the mad inmates. The fact that these were kept in "dark and dirty cloistral corridors" was the central point of criticism. This negative situation was confronted by the travellers not only with a demand for more hygiene but also with a call for an academically trained physician. Furthermore, they claimed for dissecting deceased patients in order to explore the nature of madness. A comparison of these travel reports with the first psychiatric publications of the early 19th century discloses a literary discourse. It leads from the reports of travellers with a general interest to specialist literature of early psychiatry. Obviously it had a formative influence on the self-conception of this new medical field, which benefited from the criticism concerning the allegedly inhumane conditions in the old hospitals. Three questions follow from this statement: 1. Which were the images produced or reproduced by the travellers in their reports? 2. Which were the standards against which the critics measured their reports? 3. In how far were the philanthropic aims of the enlightened travellers related to the self-conception of the hospitals and their inmates? Travelling reports are compared with the circumstances in the hospitals. This comparison throws light in the "invention" of the genre psychiatry. Furthermore, it makes clear how ambiguous the charitableness of the travelling philosophers of the Enlightenment was.

When the National Socialists came to power in 1933 psychiatry experienced a boom in Germany that was undreamed-of. Psychiatry became one of the leading disciplines because it put the theory of racial hygiene into practice, which was closely linked to the National Socialists' ideology. Coercive sterilizations performed in hundreds of thousands cases could only be carried out with the help of many deeply convinced psychiatrists. From the late 1930s on tables started to be turned: psychiatrists were more and more eclipsed by administration officers. Time consuming therapies, which were still favoured by some psychiatrists, were replaced by economy measures. The killing of patients in the years 1940/41 in the so called "Aktion T4" marked a complete change of direction. Psychiatrists' eugenic activities and their propagation of sterilizations during the 1930s were not directly linked to the so called "euthanasia". On the contrary, there was a massive shift from the elimination of diseases to the elimination of patients. This shift caused society to withdraw its formerly strong trust in psychiatry. Because psychiatrists had participated in murdering their clients the clinical practice of psychiatry and psychiatric research became superfluous. As a consequence psychiatry faced the problem how to justify its existence. During the years 1941/42 the futile quest of a psychiatric "project for the future" began. Psychiatrists tried to justify the existence of their profession by research and modernization. An attempt that was doomed to failure.

Whenever psychiatry became object of public interest it was object of criticism. Since psychiatry has been established as a medical discipline in the beginning of the 19th century, the diagnostic, therapeutic and juridical practices have been subjected to fundamental attacks. Conversely psychiatrists periodically complained about misconception in the public and press of the mentally ill, their medical treatment and the psychiatrists themselves. In their opinion the general public ignored psychiatric information and, therefore, impeded any innovation. Medical knowledge, however, appeared as a sustained means to overcome the "latent terror of colloquial language" and to improve the social status of the mentally ill. The text focuses on the discussion among West-German social-psychiatrists from 1960 to 1980 and the conception of the public as revealed in their statements. Using Thomas Gieryn's concept of professional "boundary work" it looks more closely at two controversies which attracted public as well as professional attention (and caused their irritation) in the 1970s, i.e. Frank Fischers's book "Irrenhäuser. Kranke klagen an" (1969) and the "Frankfurter Psychiatriestreit 1976".

Between 1872 and 1876 Emma Mohr (1833-?), a patient of the asylum Nietleben close to Halle, embroidered an astonishing tapestry, now in a private collection. It consists out of 48 little images surrounding a self portrait, showing biblical motives, depictions of the Emperor Wilhelm I. and several scenes out of the bourgeois life of the time which have not been identified yet. On the back of this so called "State-Album" Mohr sewed a petition to the Emperor and some accompanying letters, all diligently stitched in pieces of linen. She wanted to send the whole artefact off secretly but obviously did not succeed. The texts tell about what happened to her after she was taken to hospital in 1866. She complains in detail about how she was treated by the nurses and the psychiatrists, Heinrich Damerow (1798-1866) and Moritz Koeppe (1832-1879). The purpose of the "State-Album" was to warn the Emperor about the criminal acts of his civil servants for which her case was only an example.

Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany. In Imperial Germany psychiatrists sought to give their asylums the character of modern medical hospitals. Due to the increase of insanity defence these efforts were obstructed by the high number of inmates with a criminal background. Special departments for mentally ill criminals were founded both in asylums and in prisons. But the clientele was not welcome in any of these institutions. Thus, there was a high fluctuation between prisons and asylums. A new definition of criminal responsibility was needed. In order to keep criminals out of their hospitals psychiatrists developed the medical concept of psychopathy referring to a mental defect without lack of responsibility. On the other hand penal law reformers plead to introduce preventive measures, such as security confinement, into the criminal law book. Since the resolution of the 'law against habitual criminals' in November 1933 judges are allowed to sentence mentally ill offenders to indefinite confinement in psychiatric institutions.