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[The emergence of the German 'Anstalt': lunatic asylums and hospitals competing]. [德国“安斯塔特”的出现:疯人院和医院的竞争]。
Fritz Dross

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.

根据"大改造"这一更广泛的论点,精神病院以及医院(和监狱)应该从18世纪后期开始发展为"全面的机构",获得公共空间和进一步的资源,专门用于治疗按照现代化医学标准必须与健康公民隔离的(精神)病人。但是,面对早期综合医院根据严格的医学标准来区分可治愈的病人的巨大问题,人们感到惊讶,为什么现代医学发展出两种类型的机构,从而使其对公共资源的要求加倍。本文旨在从综合医院的角度审视19世纪初杜塞尔多夫镇的一家精神病院。通过这种方式,它试图将病人分配到一家或另一家医院的困难考虑在内。因为他们都必须证明自己有能力有效地治愈病人,所以他们必须非常清楚该让谁进入,该拒绝谁。由于他们在不同的政治层面上获得资金、组织和管理,因此依赖于不同的政府机构(城镇与地区),因此必须解决一些冲突,以便建立制度化。最后,从长远来看,两者都必须获得公众的认可和接受,这只能意味着潜在患者的接受。“整体制度”定理所开启的视角似乎并不完全有助于实现这一目的,因为它往往忽视了制度竞争以及获得潜在患者接受的过程。一个更有用的观点可能是根据当地的例子进行比较分析,这可以打开人们的视野,将监狱、精神病院和综合医院作为现代化社会中"有用"类型的组织相互竞争。
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引用次数: 0
[Associative disorder. On the relationship between the interpretation of disorder and society in the early writings of Eugen Bleuler]. (联想障碍。[论尤金·布鲁勒早期著作中对无序的解释与社会的关系]。
Brigitta Bernet

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.

1900年左右,瑞士精神病学家Eugen Bleuler提出了一种新的精神疾病解释模型:精神分裂症。他将联想思路的断裂称为该疾病的核心症状。在他1911年发表《早发性痴呆或精神分裂症群体》后不久,这个概念迅速在精神病学学科之外流行起来。与他同时代的人很早就注意到,被诊断为精神分裂症的危机与1900年左右更广泛的社会“现代性危机”之间存在着特殊的关系。作者通过对1890年至1910年间发展起来的精神分裂症理论进行重构和背景化,展示了在尤金·布鲁勒的早期著作中,对精神分裂症和社会的解释之间的这种表面上的关系是如何预先配置的。
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引用次数: 0
["Querulantenwahnsinn"--insanity or stubbornness?]. ["Querulantenwahnsinn"——疯狂还是固执?]
Karen Nolte

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.

德国精神病学概念“Querulantenwahnsinn”表达了1900年左右庇护精神病学的司法话语、批评和合法化之间的联系。本文首先对“Querulantenwahnsinn”的论述进行分析。第二步,将根据马尔堡精神病院(Landesheilanstalt Marburg)的医疗记录,构建关于这一社会和精神现象的"病人观点"(《波特》)。对患者经验的探究需要反思这样一个事实,即“Querulantenwahnsinn”的临床表现是非常可信的。它是由精神病学家创建的,作为对精神病院批评的回应。每一次试图质疑精神病院批判立场的病态化,每一次抵抗都会导致精神病学诊断的巩固。因此,病态化,被关进精神病院影响了病人的自我感知——所以他们可能违背自己的明确意愿,参与了关于“Querulantenwahnsinn”的讨论。文章指出,“Querulantenwahnsinn”的话语是威廉社会中社会矛盾和法律文化的一种表现。
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引用次数: 0
[The psychiatric criticism of social prejudices as a medical strategy of legitimation]. [精神病学对社会偏见的批判,作为一种合法化的医学策略]。
Torger Möller

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.

本文的主题是精神病学知识与社会偏见的关系。这将从医学话语的角度和科学史的角度观察癫痫的案例研究。在科学和社会日益民主化的背景下,关于癫痫患者的社会歧视的讨论在20世纪60年代和70年代进入了医学话语。在医学论述中,歧视的原因被归咎于人们中存在的由情感决定的偏见,而要通过向人们提供科学知识的教育来消除这种偏见。然而,从科学史的角度来看,很明显,在人群中发现的偏见是精神病学知识普及的结果,这种普及始于19世纪末,一直持续到20世纪。因此,这些所谓偏见的来源是科学,而不是人口。在结束语中,这些发现作为精神病学和精神病学对象合法化的不同“话语”策略进行了讨论。
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引用次数: 0
[Labour, silence and order: visualizing modern psychiatry--strategies for legitimizing Swiss asylum psychiatry in the context of occupational therapy in the interwar period]. [劳动、沉默和秩序:现代精神病学的可视化——在两次世界大战之间的职业治疗背景下,使瑞士精神病院合法化的策略]。
Urs Germann

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.

20世纪30年代,瑞士精神科医生参与了一场独特的公众运动,以提升他们职业的新形象。这次运动的结果是出版了一系列关于精神病院的小册子。这些被称为精神病院专著的书,包含了大量的摄影插图,其中大部分是病人工作时的照片。以精神病院专著中无所不在的病人的工作作为起点,本贡献考察了20世纪30年代初瑞士精神病学话语和实践中职业治疗的地位。贡献的第一部分描述和概述了第一次世界大战后几家精神病院患者工作的发展,然后转向讨论在这一时期引入一种新的更活跃的职业治疗形式(“aktivere Therapie”)。论文的第二部分分析了治疗工作在精神病学话语中的意义。它表明,瑞士精神科医生对职业疗法的热情主要是由于它能够改变精神病院的视觉外观。此外,它还指出了Eugen Bleuler的精神分裂症概念的几个特征,特别是对原发性和继发性症状的不同等级的假设和自闭症的概念,这对当代对职业治疗的理解和处理都至关重要。最后,它认为,对病人工作的医学解释,将治疗与工作纪律联系起来,是20世纪30年代瑞士精神病学公共运动中无处不在的病人工作的必要先决条件。
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引用次数: 0
[Hospitals in Hesse in the view of enlightened travellers]. [开明旅行者眼中黑森州的医院]。
Christina Vanja

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.

“Hohen Hospitäler”,由土地所有者Philipp dem grossm tigen在1533-1542年间建立的医院,被视为近代早期最伟大的明爱的表达。这些新教机构为黑森的穷人和生病的下属服务,被贵族和平民视为慈善庇护所。这种情况在18世纪末发生了巨大的变化。最早的批评者是启蒙运动时期的旅行哲学家,他们参观了黑森的“疯人院”以及其他怪异的地方。他们在旅行报告中发表了他们的经历。虽然作为综合机构的医院仍然照顾精神病人和躯体病人,但这些作者只关注精神失常的囚犯。事实上,这些被保存在“黑暗和肮脏的隐居走廊”是批评的焦点。旅行者面对这种不利的情况,不仅要求提高卫生条件,而且要求聘请受过学术训练的医生。此外,他们声称解剖死去的病人是为了探索疯狂的本质。将这些旅行报告与19世纪早期的第一批精神病学出版物进行比较,揭示了一种文学话语。它从具有一般兴趣的旅行者的报告引导到早期精神病学的专家文献。显然,它对这个新的医疗领域的自我概念产生了形成性的影响,这得益于对旧医院据称不人道条件的批评。从这句话可以引出三个问题:旅行者在他们的报告中产生或复制了哪些图像?2. 批评家衡量他们的报告的标准是什么?3.开明的旅行者的慈善目标在多大程度上与医院及其囚犯的自我概念有关?将旅行报告与医院的情况进行比较。这一对比揭示了精神病学类型的“发明”。此外,它还清楚地表明,启蒙运动的旅行哲学家们的慈善是多么含糊不清。
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引用次数: 0
[The quest of a project for the future: the National Socialistic leading discipline psychiatry and its "crisis of legitimation"]. [对未来计划的探索:国家社会主义主导学科精神病学及其“合法化危机”]。
Peter Sandner

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.

当1933年国家社会主义党上台时,精神病学在德国经历了一场做梦也想不到的繁荣。精神病学之所以成为主要学科之一,是因为它将种族卫生理论付诸实践,而种族卫生理论与纳粹的意识形态密切相关。在成千上万的案例中,强制绝育只能在许多深信不疑的精神病医生的帮助下进行。从20世纪30年代末开始,情况开始发生转变:精神科医生越来越被行政官员所掩盖。一些精神科医生仍然青睐耗时的治疗方法被经济措施所取代。在1940/41年所谓的“T4行动”中杀害病人标志着方向的彻底改变。精神科医生的优生活动和他们在20世纪30年代传播的绝育与所谓的“安乐死”没有直接联系。相反,从消灭疾病到消灭病人发生了巨大的转变。这一转变使社会对精神病学失去了以前强烈的信任。因为精神科医生参与了谋杀他们的客户,精神病学的临床实践和精神病学研究变得多余。因此,精神病学面临着如何证明其存在的问题。在1941年至1942年间,对精神病学“未来计划”的徒劳探索开始了。精神科医生试图通过研究和现代化来证明他们职业的存在。注定要失败的尝试。
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引用次数: 0
["Keine Angst vor Psychiatern." Psychiatry, critics of psychiatry and the public in the Federal Republic of Germany 1960-1980]. ["Keine anxiety vor psychiatry ."精神病学,精神病学批评家和德意志联邦共和国的公众[1960-1980]。
Cornelia Brink

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".

每当精神病学成为公众关注的对象时,它就成为批评的对象。自从精神病学在19世纪初被确立为一门医学学科以来,诊断、治疗和司法实践一直受到根本性的攻击。相反,精神科医生定期抱怨公众和媒体对精神病患者、他们的医疗和精神科医生本身的误解。在他们看来,公众忽视了精神病学的信息,因此阻碍了任何创新。然而,医学知识作为一种持续的手段出现,以克服“对口语的潜在恐惧”,并提高精神病患者的社会地位。文本侧重于讨论在西德社会精神科医生从1960年到1980年和公众的概念,因为在他们的声明中透露。使用Thomas Gieryn的专业“边界工作”概念,它更密切地关注了20世纪70年代引起公众和专业关注(并引起他们的愤怒)的两个争议,即Frank Fischers的书“Irrenhäuser”。《法兰克福精神病学》(1969)和《法兰克福精神病学》(1976)。
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引用次数: 0
["Unschuldig hier eingesperrt und ausgeplündert"--the embroidered state's almanach (1871-76) of Emma Mohr from Erfurt]. “被冤枉囚禁掠夺”——埃尔福特的祖传年鉴(18776年)
Thomas Röske

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.

1872年至1876年间,黑尔附近尼特勒本精神病院的病人艾玛·莫尔(1833-?)绣了一幅惊人的挂毯,现为私人收藏。它由48个小图像组成,围绕着一幅自画像,显示圣经的动机,对皇帝威廉一世的描绘,以及当时尚未确定的资产阶级生活的几个场景。在这本所谓的“国家相册”的背面,莫尔缝了一封给皇帝的请愿书和一些随附的信件,所有这些都是用亚麻布精心缝制的。她想把整个文物秘密送走,但显然没有成功。这些文字讲述了她在1866年被送往医院后发生的事情。她详细地抱怨了护士和精神科医生海因里希·达默罗(Heinrich Damerow, 1798-1866)和莫里茨·科佩(Moritz Koeppe, 1832-1879)是如何对待她的。“国家相册”的目的是警告皇帝他的公务员的犯罪行为,她的案件只是一个例子。
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引用次数: 0
[Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany]. 避难是为了治疗还是保护?监禁法医病人是对德意志帝国精神病院的挑战[j]。
Christian Müller

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.

庇护是为了治疗还是保护?法庭病人的禁闭是对德意志帝国精神病院的挑战。在德意志帝国,精神科医生试图使他们的精神病院具有现代医院的特点。由于精神错乱辩护的增加,这些努力受到大量有犯罪背景的囚犯的阻碍。在精神病院和监狱中都成立了专门的精神病罪犯部门。但这些机构都不欢迎这些客户。因此,监狱和收容所之间的变动很大。需要对刑事责任作出新的定义。为了把罪犯赶出医院,精神科医生发展了精神病的医学概念,指的是一种没有责任的精神缺陷。另一方面,刑法改革者呼吁在刑法中引入安全监禁等预防措施。自从1933年11月通过“反对惯犯法”以来,法官被允许判处精神病罪犯在精神病院无限期监禁。
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引用次数: 0
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Medizin, Gesellschaft, und Geschichte : Jahrbuch des Instituts fur Geschichte der Medizin der Robert Bosch Stiftung
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